Domínguez-Rodríguez Luis Manuel, Dobarro David, Iglesias-Otero Carla, Crespo-Leiro María G, Raposeiras-Roubín Sergio, Álvarez-García Jesús, Barreiro-Pérez Manuel, Muñoz-Pousa Isabel, Sánchez-Recalde Angel, Íñiguez-Romo Ándrés, Zamorano José Luis
Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Universidad de Alcalá, Madrid, Spain.
Eur J Heart Fail. 2025 Mar;27(3):442-452. doi: 10.1002/ejhf.3556. Epub 2024 Dec 18.
No study has analyzed the impact of guideline-directed medical therapy in preventing heart failure (HF) relapse in patients with arrhythmia-induced cardiomyopathy (AiCM) following left ventricular ejection fraction (LVEF) improvement.
We analyzed data from a single-center cohort of 200 patients admitted for HF, LVEF <50% and cardiac arrhythmia considered by cardiologists to be the precipitating cause of the episode. The primary endpoint was time-to-HF relapse, defined as the composite of readmission for HF, Emergency Department (ED) visit for HF, or significant decline in LVEF. Changes in medication were recorded and a time-varying multivariate Cox regression was performed. After a median follow-up period of 6.14 years, diagnostic confirmation was achieved in 188 out of the initial 200 patients with suspected AiCM. A total of 89 patients (47.3%) met the primary endpoint. RAS inhibitors (adjusted hazard ratio (HR) 0.50 [0.31-0.81]; p = 0.005) and beta-blockers (adjusted HR 0.48 [0.28-0.81]; p = 0.006) were associated with a lower incidence of relapse. Mineralocorticoid receptor antagonists were associated with a significantly lower incidence of ED visits for HF (adjusted HR 0.38 [0.15-0.95]; p = 0.038), but did not achieve statistical significance for the combined primary endpoint. Antiarrhythmic drugs did not show a significant impact on the primary endpoint.
Maintaining RAS inhibitors and beta-blockers was associated with a significantly lower incidence of relapse in the setting of AiCM with improved LVEF.
尚无研究分析在左心室射血分数（LVEF）改善后，遵循指南的药物治疗对心律失常性心肌病（AiCM）患者预防心力衰竭（HF）复发的影响。
我们分析了来自单中心队列的200例因HF入院的患者的数据，这些患者的LVEF<50%，且心脏病专家认为心律失常是此次发作的诱发原因。主要终点是HF复发时间，定义为因HF再次入院、因HF到急诊科就诊或LVEF显著下降的综合情况。记录用药变化，并进行时变多变量Cox回归分析。在中位随访期6.14年之后，最初怀疑患有AiCM的200例患者中有188例得到诊断确认。共有89例患者（47.3%）达到主要终点。RAS抑制剂（调整后风险比（HR）0.50[0.31 - 0.81]；p = 0.005）和β受体阻滞剂（调整后HR 0.48[0.28 - 0.81]；p = 0.006）与较低的复发率相关。盐皮质激素受体拮抗剂与因HF到急诊科就诊的发生率显著降低相关（调整后HR 0.38[0.15 - 0.95]；p = 0.038），但对于合并的主要终点未达到统计学显著性。抗心律失常药物对主要终点未显示出显著影响。
在LVEF改善的AiCM患者中，维持使用RAS抑制剂和β受体阻滞剂与显著较低的复发率相关。
