Benedetti Alice, Wilgenhof Adriaan, Castaldi Gianluca, Vescovo Giovanni M, Poletti Enrico, Paradies Valeria, Bringmans Tijs, Segers Vincent Frans Maria, Ameloot Koen, Prihadi Edgard, Agostoni Pierfrancesco, Convens Carl, Scott Benjamin, Verheye Stefan, Vermeersch Paul, De Greef Yves, Schwagten Bruno, Wolf Michael, De Keulenaer Gilles, Zivelonghi Carlo
Hartcentrum, Ziekenhuis Aan de Stroom (ZAS), Antwerp, Belgium.
Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands.
Catheter Cardiovasc Interv. 2025 Jul;106(1):317-324. doi: 10.1002/ccd.31562. Epub 2025 Apr 24.
Arrhythmia-induced cardiomyopathy (AIC) is defined as impaired left ventricular function due to cardiac arrhythmias. We sought to investigate the association between coronary microvascular dysfunction (CMD) and AIC in patients with atrial fibrillation (AF).
In this multicenter observational study, we enrolled consecutive patients with recent diagnosis of AF (<6 months) who underwent invasive coronary physiology assessment with the bolus thermodilution technique. Patients were divided into two groups according to left ventricular ejection fraction (LVEF): AIC group if LVEF < 50% and preserved LVEF group if LVEF ≥ 50%. A third group of patients with a recent diagnosis of dilated cardiomyopathy (DCM) and without AF was analyzed as control group. CMD was defined as abnormal coronary flow reserve (CFR < 2.5) and/or abnormal index of microcirculatory resistance (IMR ≥ 25).
Among 84 analyzed patients, 33 were in the AIC group, 39 in the preserved LVEF group, and 12 in the DCM group. CMD was more frequently detected in the AIC group compared to the preserved LVEF (79% vs. 38%, p < 0.001) and DCM groups (79% vs. 33%, p = 0.01). In patients with AF, a significant correlation was found between CFR and LVEF (beta coefficient: 3.8; 95% CI: 1.8-5.9; p < 0.001), and IMR and LVEF (beta coefficient: -0.3; 95% CI: -0.4 to -0.1; p = 0.001). At multivariable analysis, CMD was independently associated with AIC (adjusted odds ratio: 6.2; 95% CI: 2.2 to 20.1; p = 0.001).
CMD is strongly and independently associated with the degree of left ventricular dysfunction and may play a role in the development of AIC in patients with AF.
心律失常性心肌病（AIC）定义为因心律失常导致的左心室功能受损。我们旨在研究房颤（AF）患者冠状动脉微血管功能障碍（CMD）与AIC之间的关联。
在这项多中心观察性研究中，我们纳入了近期诊断为房颤（<6个月）且接受了团注热稀释技术进行有创冠状动脉生理学评估的连续患者。根据左心室射血分数（LVEF）将患者分为两组：LVEF<50%为AIC组，LVEF≥50%为LVEF保留组。将第三组近期诊断为扩张型心肌病（DCM）且无房颤的患者作为对照组进行分析。CMD定义为冠状动脉血流储备异常（CFR<2.5）和/或微循环阻力指数异常（IMR≥25）。
在84例分析患者中，AIC组33例，LVEF保留组39例，DCM组12例。与LVEF保留组（79%对38%，p<0.001）和DCM组（79%对33%，p=0.01）相比，AIC组更频繁地检测到CMD。在房颤患者中，发现CFR与LVEF之间存在显著相关性（β系数：3.8；95%CI：1.8-5.9；p<0.001），IMR与LVEF之间也存在显著相关性（β系数：-0.3；95%CI：-0.4至-0.1；p=0.001）。在多变量分析中，CMD与AIC独立相关（调整后的优势比：6.2；95%CI：2.2至20.1；p=0.001）。
CMD与左心室功能障碍程度密切且独立相关，可能在房颤患者AIC的发生中起作用。
