Miric Dino, Juric Paic Marina, Borovac Josip Andelo
Cardiovascular Diseases Department, University Hospital of Split, Soltanska 1, 21000 Split, Croatia.
Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia.
Eur Heart J Case Rep. 2024 Sep 5;8(9):ytae481. doi: 10.1093/ehjcr/ytae481. eCollection 2024 Sep.
The SGLT2 inhibitor empagliflozin has recently gained approval for treating heart failure (HF) across the entire spectrum of ejection fractions including heart failure with preserved ejection fraction (HFpEF). Bradycardia-induced HF, previously described in the literature as bradycardiomyopathy, is an uncommon cause of HFpEF.
Herein, we describe a case of a young, 32-year-old woman with no prior medical history who was referred to the hospital due to progressive fatigue and exercise intolerance. She exhibited junctional bradycardia and sinus node dysfunction on electrocardiographic examination, was hypotensive, and had significantly elevated NT-proBNP levels at admission. Transthoracic echocardiographic examination (TTE) revealed preserved systolic function of the left ventricle with segmental abnormalities of contractility and reduced global longitudinal strain, indicative of HFpEF. Cardiac magnetic resonance imaging showed hypertrabeculations, suggesting noncompaction cardiomyopathy (NCCM), even though the definitive diagnostic criteria for NCCM were not met. The patient reported no recent episodes of fever and no chest pain. A comprehensive panel for cardiotropic viruses and Lyme disease were negative while infiltrative diseases such as sarcoidosis were clinically ruled out. Coronary angiography excluded coronary artery disease. Due to profound hypotension and bradycardia, we prescribed empagliflozin and theophylline. At the subsequent follow-up visit within 1 month, the patient reported that she was asymptomatic, with restored sinus rhythm, and complete normalization of NT-proBNP values.
Bradycardia-induced HFpEF is a rare entity that can limit the use of most cardiovascular pharmacotherapies but can be successfully treated with empagliflozin and theophylline as demonstrated in our case.
钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂恩格列净最近已获批用于治疗射血分数全范围的心力衰竭（HF），包括射血分数保留的心力衰竭（HFpEF）。心动过缓诱发的HF，以前在文献中称为心动过缓性心肌病，是HFpEF的一种罕见病因。
在此，我们描述了一名32岁的年轻女性病例，她既往无病史，因进行性疲劳和运动不耐受而入院。心电图检查显示她存在交界性心动过缓和窦房结功能障碍，血压低，入院时N末端B型利钠肽原（NT-proBNP）水平显著升高。经胸超声心动图检查（TTE）显示左心室收缩功能保留，但有节段性收缩异常和整体纵向应变降低，提示HFpEF。心脏磁共振成像显示心肌小梁增多，提示心肌致密化不全心肌病（NCCM），尽管未达到NCCM的明确诊断标准。患者报告近期无发热及胸痛发作。针对嗜心性病毒和莱姆病的综合检测均为阴性，同时临床上排除了结节病等浸润性疾病。冠状动脉造影排除了冠状动脉疾病。由于严重低血压和心动过缓，我们给予恩格列净和茶碱治疗。在随后1个月内的随访中，患者报告无症状，窦性心律恢复，NT-proBNP值完全正常。
心动过缓诱发的HFpEF是一种罕见疾病，会限制大多数心血管药物治疗的应用，但如我们的病例所示，恩格列净和茶碱可成功治疗该疾病。
