Esteban-Fernández Alberto, Gómez-Otero Inés, López-Fernández Silvia, López-Vilella Raquel, Pastor-Pérez Francisco, Otero-García Óscar, Rodríguez-Santamarta Miguel, García-Vega David, Fluvià Paula, Donoso-Trenado Víctor, Sánchez-Corral Ester, García-Pinilla José Manuel, Bonilla-Palomas Juan Luis, López López Andrea, González-Juanatey José Ramón, Bonet Luis Almenar
Cardiology Service, Hospital Universitario Severo Ochoa, Calle Orellana S/N. 28911, Leganés, Madrid, Spain.
Faculty of Health Sciences, Universidad Alfonso X el Sabio (UAX), Villanueva de la Cañada, Madrid, Spain.
Clin Res Cardiol. 2025 May 6. doi: 10.1007/s00392-025-02663-y.
Heart failure (HF) secondary to tachycardia-induced cardiomyopathy (TIC) is often underdiagnosed due to inconsistent definitions and perceived reversibility. The treatment focuses on early arrhythmia control, but the impact of guideline-directed medical therapy (GDMT) on left ventricular ejection fraction (LVEF) improvement has not been fully explored.
This multicentric prospective registry study included patients with newly onset HF and reduced ejection fraction (HFrEF). Data were collected on clinical characteristics, echocardiographic and laboratory parameters, pharmacological treatment, and follow-up events. The statistical analyses focused on TIC patients, analyzing the event rates and the influence of GDMT on LVEF improvement according to sinus rhythm (SR) restoration.
Among 808 patients, 174 (21.5%) were diagnosed with TIC, with an age of 67.2 (SD: 9.4) years. After a median follow-up of 3.5 months [IQR: 2.6-4.3], SR was restored in 56.8% of patients, and LVEF improved from 29.6 to 49%. The increase was more pronounced in patients who restored SR compared to those remaining in atrial fibrillation (AF) (22.4% vs. 15.1%; p < 0.05). The natriuretic peptides significantly decreased in the SR group (- 1883.7 pg/mL) but did not in the AF group. The overall readmission rate was 25.1% and the overall mortality rate was 3.6%, with no significant differences between patients who achieved SR and those with persistent AF at the end of up-titration. HF readmission was infrequent (4%) despite AF persistence. Early GDMT was initiated in TIC patients, regardless of SR recovery and significantly improved LVEF, especially in AF patients [RR = 4.24 (95% CI: 1.44-12.45)] compared to SR patients [(RR = 1.41 95% CI: 1.02-1.92)].
TIC represents a significant proportion of HFrEF patients, with early restoration of SR leading to greater LVEF improvement. Despite AF persistence, HF readmissions were rare, highlighting the efficacy of early quadruple therapy. Enhanced adherence to GDMT should be prioritized, particularly in patients with persistent AF.
由于定义不一致和认为具有可逆性，心动过速性心肌病（TIC）继发的心力衰竭（HF）常常未得到充分诊断。治疗重点在于早期心律失常控制，但指南指导的药物治疗（GDMT）对左心室射血分数（LVEF）改善的影响尚未得到充分研究。
这项多中心前瞻性注册研究纳入了新发HF且射血分数降低（HFrEF）的患者。收集了临床特征、超声心动图和实验室参数、药物治疗及随访事件的数据。统计分析聚焦于TIC患者，根据窦性心律（SR）恢复情况分析事件发生率以及GDMT对LVEF改善的影响。
在808例患者中，174例（21.5%）被诊断为TIC，年龄为67.2（标准差：9.4）岁。中位随访3.5个月[四分位间距：2.6 - 4.3]后，56.8%的患者恢复了SR，LVEF从29.6%提高到49%。与仍处于房颤（AF）的患者相比，恢复SR的患者LVEF升高更显著（22.4%对15.1%；p < 0.05）。SR组利钠肽显著降低（-1883.7 pg/mL），而AF组未降低。总体再入院率为25.1%，总体死亡率为3.6%，在滴定终点时，恢复SR的患者与持续性AF患者之间无显著差异。尽管AF持续存在，但HF再入院很少见（4%）。TIC患者无论SR是否恢复均启动早期GDMT，且显著改善了LVEF，尤其是AF患者[风险比 = 4.24（95%置信区间：1.44 - 12.45）]，相比SR患者[风险比 = 1.41 95%置信区间：1.02 - 1.92]。
TIC在HFrEF患者中占相当比例，早期恢复SR可使LVEF有更大改善。尽管AF持续存在，但HF再入院很少见，突出了早期四联疗法的疗效。应优先加强对GDMT的依从性，尤其是持续性AF患者。
