Fujino Tadashi, Yamashita Takeshi, Suzuki Shinya, Sugiyma Hiroaki, Sagara Koichi, Sawada Hitoshi, Aizawa Tadanori, Igarashi Masaki, Yamazaki Junichi
Cardiovascular Institute Hospital, Department of Cardiovascular Medicine, Toho University Omori Medical Center, 6-11-1 Omorinishi, Ota-ku, Tokyo 143-8541, Japan.
Circ J. 2007 Jun;71(6):936-40. doi: 10.1253/circj.71.936.
Sustained tachycardia causes left ventricular (LV) systolic dysfunction leading to heart failure (HF), which is widely known as "tachycardia-induced cardiomyopathy (TIC)", but its prevalence and prognosis in Japanese remain unclear.
Of 213 consecutive patients with HF associated with atrial fibrillation (AF) requiring hospitalization (n=213) between January 1999 and December 2004, and 104 (83 males, 67+/-12.6 years) were identified as not having any structural heart disease. Of them 41 (39%) had a normal LV ejection fraction (LVEF) at the initial admission, and the remaining patients fell into 2 groups: those with rapid (<6 months) normalization of the LVEF after AF management (presumed TIC, 30 patients, 29%) and those with persistent LV systolic dysfunction (dilated cardiomyopathy (DCM), 33 patients, 32%). Although the B-type natriuretic peptide value and LVEF did not differ between the 2 groups, the LV size on admission was significantly smaller in the TIC group (LV end-diastolic dimension (LVDd) 57.6+/-7.2, LV end-systolic dimension (LVDs) 49.4+/-8.0) than in the DCM group (LVDd 63.4 +/-8.8, LVDs 55.3+/-9.6, p<0.05). During a follow-up period of 42.1+/-21.2 months, cardiac death and recurrent HF hospitalization were significantly less frequent in the TIC group than in the DCM group.
In AF-associated HF requiring hospitalization, TIC is the presumed cause in approximately one-third of patients without any previously known structural heart disease. That particular group is characterized by a relatively smaller LV and better prognosis under medical treatment.
持续性心动过速会导致左心室（LV）收缩功能障碍，进而引发心力衰竭（HF），这被广泛称为“心动过速性心肌病（TIC）”，但其在日本的患病率和预后仍不明确。
在1999年1月至2004年12月期间连续收治的213例因心房颤动（AF）合并心力衰竭而需住院治疗的患者（n = 213）中，有104例（83例男性，年龄67±12.6岁）被确定没有任何结构性心脏病。其中41例（39%）在初次入院时左心室射血分数（LVEF）正常，其余患者分为两组：房颤治疗后LVEF迅速（<6个月）恢复正常的患者（推测为TIC，30例，29%）和持续性左心室收缩功能障碍的患者（扩张型心肌病（DCM），33例，32%）。尽管两组之间B型利钠肽值和LVEF无差异，但TIC组入院时的左心室大小明显小于DCM组（左心室舒张末期内径（LVDd）57.6±7.2，左心室收缩末期内径（LVDs）49.4±8.0）（DCM组LVDd 63.4±8.8，LVDs 55.3±9.6，p<0.05）。在42.1±21.2个月的随访期内，TIC组的心脏死亡和复发性心力衰竭住院发生率明显低于DCM组。
在因房颤合并心力衰竭而需住院治疗的患者中，约三分之一无既往已知结构性心脏病的患者推测病因是TIC。该特定群体的特点是左心室相对较小，且药物治疗预后较好。
