Department of Clinical Laboratory, Osaka City General Hospital.
Department of Cardiology, Osaka City General Hospital.
Int Heart J. 2023;64(3):386-393. doi: 10.1536/ihj.22-648.
Arrhythmia-induced cardiomyopathy (AIC) occurring in patients with atrial fibrillation (AF) is a reversible form of cardiomyopathy characterized by LV systolic dysfunction. However, it is difficult to predict the reversibility before rhythm control therapy. We performed this study to develop a parameter for the identification of AIC in routine transthoracic echocardiography (TTE) in patients with presumptive AIC due to AF.We retrospectively studied 72 patients treated with catheter ablation therapy for persistent AF, and LV ejection fraction (LVEF) ≤ 45%. The patients were divided into 2 groups by follow-up TTE performed within 12 ± 6 months postoperatively. Patients with ≥ 15% improvement in LVEF or ≥ 10% improvement and ≥ 50% in LVEF were classified as the AIC group, and the others were classified as the non-AIC group.A total of 57 (79%) patients were classified as the AIC group. In the stepwise multivariate logistic regression model, LV end-diastolic dimension (LVDd) and e' (septal) were independent predictors of AIC. The sensitivities of LVDd ≤ 53 mm and e' (septal) ≥ 6.3 cm/second were 60% and 75%, respectively. Their specificities were 80% and 67%, respectively. The presence of either LVDd ≤ 53 mm or e' (septal) ≥ 6.3 cm/second had a higher sensitivity (90%); their co-occurrence had a higher specificity (93%) in predicting AIC.The functional recovery in patients with AIC can occur in LV systolic dysfunction without remodeling and impairment of relaxation. The combination of LVDd and e' (septal) is useful in predicting AIC due to AF with routine TTE.
心律失常性心肌病（AIC）发生于房颤（AF）患者，是一种以左心室收缩功能障碍为特征的可逆转性心肌病。然而，在节律控制治疗之前，很难预测其可逆性。我们进行这项研究，旨在通过常规经胸超声心动图（TTE）为疑似 AF 所致 AIC 的患者识别 AIC 参数。
我们回顾性研究了 72 例接受导管消融治疗持续性 AF 且左心室射血分数（LVEF）≤45%的患者。根据术后 12±6 个月内进行的随访 TTE，将患者分为 2 组。LVEF 改善≥15%或改善≥10%且≥50%的患者被归类为 AIC 组，其余患者被归类为非 AIC 组。共有 57（79%）例患者被归类为 AIC 组。在逐步多元逻辑回归模型中，LV 舒张末期内径（LVDd）和 e'（间隔）是 AIC 的独立预测因子。LVDd≤53mm 和 e'（间隔）≥6.3cm/sec 的灵敏度分别为 60%和 75%，特异度分别为 80%和 67%。两者中任意一个的存在（LVDd≤53mm 或 e'（间隔）≥6.3cm/sec）的预测 AIC 的灵敏度更高（90%）；两者同时存在的特异性更高（93%）。AIC 患者的左心室收缩功能障碍可能会在无重构和舒张功能障碍的情况下恢复正常。在常规 TTE 中，LVDd 和 e'（间隔）的联合应用有助于预测 AF 所致的 AIC。
