Vera Alberto, Cecconi Alberto, Martínez-Vives Pablo, López-Melgar Beatriz, Olivera María José, Hernández Susana, Rojas-González Antonio, Díez-Villanueva Pablo, Salamanca Jorge, Caballero Paloma, Jiménez-Borreguero Luis Jesús, Alfonso Fernando
Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, C/Diego de León 62, Madrid, 28006, Madrid, Spain.
Radiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, Madrid, Spain.
Heart Vessels. 2025 Apr;40(4):332-340. doi: 10.1007/s00380-024-02471-w. Epub 2024 Oct 8.
Differentiation of tachycardia-induced cardiomyopathy (TIC) from dilated cardiomyopathy (DCM) in patients admitted for heart failure (HF) with left ventricular dysfunction and supraventricular tachyarrhythmia (SVT) remains challenging. The role of tissue tracking (TT) in this setting remains unknown.
Forty-three consecutive patients admitted for HF due to SVT with left ventricular ejection fraction (LVEF) < 50% undergoing CMR were retrospectively included. Those eventually evolving to LVEF > 50% at follow-up were classified as TIC and those maintaining a LVEF < 50% were classified as DCM. Clinical, echocardiography, and CMR findings, including TT, were analyzed to predict LVEF recovery.
Twenty-five (58%) patients were classified as TIC. Late gadolinium enhancement (LGE) was more frequent in DCM group (61% vs 16%, p = 0.004). Left ventricle (LV) peak systolic radial velocity and peak diastolic radial strain rate were lower in DCM group (7.24 ± 4.44 mm/s vs 10.8 ± 4.5 mm/s; p = 0.015 and -0.12 ± 0.33 1/s vs -0.48 ± 0.51 1/s; p = 0.016, respectively). Right ventricle (RV) peak circumferential displacement was lower in patients with TIC (0.2 ± 1.3 vs 1.3 ± 0.9°; p = 0.009). In the multivariate analysis, diabetes (p = 0.046), presence of LGE (p = 0.028), LV peak systolic radial velocity < 7.5 mm/s (p = 0.034), and RV peak circumferential displacement > 0.5° (p = 0.028) were independent predictors of lack of LVEF recovery.
In the setting of acute HF with LV dysfunction related to SVT, diabetes, LGE, LV peak systolic velocity, and RV peak circumferential displacement are independent predictors of lack of LVEF recovery and, therefore, represent clinically useful parameters to differentiate TIC from DCM.
对于因心力衰竭（HF）合并左心室功能障碍及室上性快速心律失常（SVT）入院的患者，鉴别心动过速性心肌病（TIC）与扩张型心肌病（DCM）仍然具有挑战性。组织追踪（TT）在此情况下的作用尚不清楚。
回顾性纳入43例因SVT导致HF且左心室射血分数（LVEF）<50%而接受心脏磁共振成像（CMR）检查的连续患者。随访中最终LVEF升高至>50%的患者被归类为TIC，LVEF维持在<50%的患者被归类为DCM。分析临床、超声心动图及CMR检查结果（包括TT）以预测LVEF恢复情况。
25例（58%）患者被归类为TIC。延迟钆增强（LGE）在DCM组更常见（61%对16%，p = 0.004）。DCM组左心室（LV）收缩期峰值径向速度及舒张期峰值径向应变率较低（7.24±4.44 mm/s对10.8±4.5 mm/s；p = 0.015以及-0.12±0.33 1/s对-0.48±0.51 1/s；p = 0.016）。TIC患者右心室（RV）圆周方向峰值位移较低（0.2±1.3对1.3±0.9°；p = 0.009）。多因素分析中，糖尿病（p = 0.046）、存在LGE（p = 0.028）、LV收缩期峰值径向速度<7.5 mm/s（p = 0.034）以及RV圆周方向峰值位移>0.5°（p = 0.028）是LVEF未恢复的独立预测因素。
在因SVT导致的急性HF合并LV功能障碍的情况下，糖尿病、LGE、LV收缩期峰值速度及RV圆周方向峰值位移是LVEF未恢复的独立预测因素，因此是区分TIC与DCM的临床有用参数。
