Ermert Lynn, Kreimer Fabienne, Quast Daniel R, Pflaumbaum Andreas, Mügge Andreas, Gotzmann Michael
University Hospital St. Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr-University Bochum, Bochum, Germany.
University Hospital St. Josef-Hospital Bochum, Internal Medicine, Ruhr-University Bochum, Bochum, Germany.
Front Cardiovasc Med. 2023 Jan 12;9:940060. doi: 10.3389/fcvm.2022.940060. eCollection 2022.
Atrial fibrillation (AF) and atrial flutter (AFL) induced tachycardiomyopathy (TCM) has been known to cause reversible heart failure (HF) for many years. However, the prevalence of the disease is unknown, and diagnosis is challenging. Therefore, the aim of the present study was (1) to assess the rate of AF/AFL induced TCM and (2) to identify indicators for diagnosis.
Consecutively, all patients with a diagnosis of HF who were hospitalized in our department within 12 months were reviewed. For the main analysis, all patients with HF with reduced ejection fraction (HFrEF) and AF or AFL were included. AF/AFL induced TCM was diagnosed when there was at least a 10% improvement in left ventricular ejection fraction under rhythm or rate control within 3 months. Patients with HFrEF with AF/AFL but without TCM served as control group.
A total of 480 patients were included. AF/AFL induced TCM occurred in 26 patients (5.4%) and HFrEF with AF/AFL in 53 patients (11%). Independent indicators of AF/AFL induced TCM were age<79 years [Odds ratio 5.887, confidence interval (CI) 1.999-17.339, < 0.001], NT-pro-BNP <5,419 pg/mL (Odds ratio 2.327, CI 1.141-4.746, = 0.004), and a resting heart rate >112 bpm (Odds ratio 2.503, CI 1.288-4.864, = 0.001).
Approximately 5% of all patients hospitalized for HF suffer from AF/AFL induced TCM. Improved discrimination of AF/AFL induced TCM to HFrEF with AF/AFL is possible considering age, NT-pro-BNP level, and resting heart rate >112 beats/minute. Based on these parameters, an earlier diagnosis and improved therapy might be possible.
多年来已知心房颤动（AF）和心房扑动（AFL）诱发的心动过速性心肌病（TCM）可导致可逆性心力衰竭（HF）。然而，该病的患病率尚不清楚，诊断也具有挑战性。因此，本研究的目的是：（1）评估AF/AFL诱发的TCM的发生率；（2）确定诊断指标。
连续回顾了12个月内在我科住院的所有诊断为HF的患者。主要分析纳入了所有射血分数降低的心力衰竭（HFrEF）且伴有AF或AFL的患者。当在3个月内通过节律或心率控制使左心室射血分数至少提高10%时，诊断为AF/AFL诱发的TCM。伴有AF/AFL但无TCM的HFrEF患者作为对照组。
共纳入480例患者。AF/AFL诱发的TCM发生在26例患者中（5.4%），伴有AF/AFL的HFrEF患者有53例（11%）。AF/AFL诱发的TCM的独立指标为年龄<79岁[比值比5.887，置信区间（CI）1.999 - 17.339，P<0.001]、N末端B型利钠肽原（NT-pro-BNP）<5419 pg/mL（比值比2.327，CI 1.141 - 4.746，P = 0.004）以及静息心率>112次/分钟（比值比2.503，CI 1.288 - 4.864，P = 0.001）。
因HF住院的所有患者中约5%患有AF/AFL诱发的TCM。考虑年龄、NT-pro-BNP水平以及静息心率>112次/分钟，有可能更好地区分AF/AFL诱发的TCM与伴有AF/AFL的HFrEF。基于这些参数，可能实现更早的诊断和更好的治疗。
