Eighteen Months Follow-up In Patients With Tachycardia-induced Cardiomyopathy

Abstract

One of the causes of chronic heart failure (HF) may be tachycardia-induced cardiomyopathy (TIC) - a heart disease that occurs with persistent supraventricular tachyarrhythmia, characterized by partially or completely reversible dysfunction and dilatation of the ventricles. The long-term prognosis in these patients is poorly understood. Objective: To evaluate the rate of rehospitalisation and the dynamics of the left ventricular ejection fraction in patients with TIC in 6 to 18 months after discharge from the hospital. Materials and methods: A retrospective analysis of patients diagnosed with TIC was carried out from January 2019 to February 2021. The diagnosis of TIC corresponded to the following signs: a stable tachycardia with more 100 beats per min; left ventricular ejection fraction (LVEF) <45%; exclusion of other causes of heart failure; partial or complete restoration of LVEF after restoration and maintenance of sinus rhythm or heart rate control. Patients were monitored by phone calls and called for follow-up of a transthoracic echocardiography. A total of 52 patients were examined, including 40 men (76.9%) 64.4 ± 10.3 (33; 88) years old. The most common cause of TIC was atrial fibrillation, recorded in 48 (92.3%) patients, in 4 (7.69%) patients - atrial flutter. In 46 (88.5%) patients, arterial hypertension was previously diagnosed, and in 12 (23.1%) cases - type 2 diabetes mellitus. Initial LVEF at hospitalization was 40.3 ± 8.2%, while LVEF <35% was recorded in 15 (28.85%) patients. Patient management was in accordance with clinical guidelines. Patients were treated during an episode of tachyarrhythmia and after restoration of sinus rhythm. Dynamic monitoring of echocardiography was possible in 26 patients. Differences were considered statistically significant at p <0.05. Results: The average follow-up period was 18,4 ± 6 [4; 27] months. With control echocardiography in 17 (32.69%) people the LVEF was more than 45%. During the observation period, 7 patients (13.46%) died, non-cardiovascular causes predominated in the mortality structure: in 4 patients (7.69%), death was due to oncopathology and in 1 patient (1.92%) due to coronavirus infection. The mean value of LVEF with control echocardiography was 47.8 ± 9.3% [31; 66] (p <0.0001) (Pic.1). In 3 (3.85%) patient, LVEF remained <35%. In 5 (9.62%) patients, LVEF after treatment increased, but remained <45%. Conclusion: The data of the presented long-term follow-up of patients with TIC indicate a favorable course in most cases, regardless of (or in despite of) the initial LVEF. One of the causes of chronic heart failure (HF) may be tachycardia-induced cardiomyopathy (TIC) - a heart disease that occurs with persistent supraventricular tachyarrhythmia, characterized by partially or completely reversible dysfunction and dilatation of the ventricles. The long-term prognosis in these patients is poorly understood. Objective: To evaluate the rate of rehospitalisation and the dynamics of the left ventricular ejection fraction in patients with TIC in 6 to 18 months after discharge from the hospital. Materials and methods: A retrospective analysis of patients diagnosed with TIC was carried out from January 2019 to February 2021. The diagnosis of TIC corresponded to the following signs: a stable tachycardia with more 100 beats per min; left ventricular ejection fraction (LVEF) <45%; exclusion of other causes of heart failure; partial or complete restoration of LVEF after restoration and maintenance of sinus rhythm or heart rate control. Patients were monitored by phone calls and called for follow-up of a transthoracic echocardiography. A total of 52 patients were examined, including 40 men (76.9%) 64.4 ± 10.3 (33; 88) years old. The most common cause of TIC was atrial fibrillation, recorded in 48 (92.3%) patients, in 4 (7.69%) patients - atrial flutter. In 46 (88.5%) patients, arterial hypertension was previously diagnosed, and in 12 (23.1%) cases - type 2 diabetes mellitus. Initial LVEF at hospitalization was 40.3 ± 8.2%, while LVEF <35% was recorded in 15 (28.85%) patients. Patient management was in accordance with clinical guidelines. Patients were treated during an episode of tachyarrhythmia and after restoration of sinus rhythm. Dynamic monitoring of echocardiography was possible in 26 patients. Differences were considered statistically significant at p <0.05. Results: The average follow-up period was 18,4 ± 6 [4; 27] months. With control echocardiography in 17 (32.69%) people the LVEF was more than 45%. During the observation period, 7 patients (13.46%) died, non-cardiovascular causes predominated in the mortality structure: in 4 patients (7.69%), death was due to oncopathology and in 1 patient (1.92%) due to coronavirus infection. The mean value of LVEF with control echocardiography was 47.8 ± 9.3% [31; 66] (p <0.0001) (Pic.1). In 3 (3.85%) patient, LVEF remained <35%. In 5 (9.62%) patients, LVEF after treatment increased, but remained <45%. Conclusion: The data of the presented long-term follow-up of patients with TIC indicate a favorable course in most cases, regardless of (or in despite of) the initial LVEF.