Time to Recovery from Systolic Dysfunction Correlates with Left Ventricular Fibrosis in Arrhythmia-Induced Cardiomyopathy

Overview

Journal Life (Basel)

Specialty Biology

Date 2024 Mar 28

PMID 38541655

Authors

Christian Schach

Daniel Lavall

Nicola Vosshage

Thomas Kortl

Christine Meindl

Ekrem Ucer

Okka Hamer

Lars S Maier

Rolf Wachter

Samuel Sossalla

Affiliations

Soon will be listed here.

Abstract

Background: Arrhythmia-induced cardiomyopathy (AIC) is characterized by the reversibility of left ventricular (LV) systolic dysfunction (LVSD) after rhythm restoration. This study is a cardiac magnetic resonance tomography substudy of our AIC trial with the purpose to investigate whether left ventricular fibrosis affects the time to recovery (TTR) in patients with AIC.

Method: Patients with newly diagnosed and otherwise unexplainable LVSD and tachyarrhythmia were prospectively recruited. LV ejection fraction (LVEF) was measured by echocardiography at baseline and 2, 4, and 6 months after rhythm control, and stress markers were assessed. After initial rhythm control, LV fibrosis was assessed through late gadolinium enhancement (LGE). Patients were diagnosed with AIC if their LVEF improved by ≥15% (or ≥10% when LVEF reached ≥50%). Non-responders served as controls (non-AIC).

Results: The LGE analysis included 39 patients, 31 of whom recovered (AIC). LV end-systolic diameters decreased and LVEF increased during follow-up. LV LGE content correlated positively with TTR (r = 0.63, = 0.003), with less LGE favoring faster recovery, and negatively with ΔLVEF (i.e., LVEF at month 2 compared to baseline) as a marker of fast recovery (r = -0.55, = 0.012), suggesting that LV fibrosis affects the speed of recovery.

Conclusion: LV fibrosis correlated positively with the time to recovery in patients with AIC. This correlation may help in the estimation of the recovery period and in the optimization of diagnostic and therapeutic strategies for patients with AIC.

References

Dubach P, Myers J, Bonetti P, Schertler T, Froelicher V, Wagner D . Effects of bisoprolol fumarate on left ventricular size, function, and exercise capacity in patients with heart failure: analysis with magnetic resonance myocardial tagging. Am Heart J. 2002; 143(4):676-83. DOI: 10.1067/mhj.2002.121269. View

Santhanakrishnan R, Wang N, Larson M, Magnani J, McManus D, Lubitz S . Atrial Fibrillation Begets Heart Failure and Vice Versa: Temporal Associations and Differences in Preserved Versus Reduced Ejection Fraction. Circulation. 2016; 133(5):484-92. PMC: 4738087. DOI: 10.1161/CIRCULATIONAHA.115.018614. View

Raymond R, Lee A, Messineo F, Manning W, Silverman D . Cardiac performance early after cardioversion from atrial fibrillation. Am Heart J. 1998; 136(3):435-42. DOI: 10.1016/s0002-8703(98)70217-0. View

Abraham W, Young J, Leon A, Adler S, Bank A, Hall S . Effects of cardiac resynchronization on disease progression in patients with left ventricular systolic dysfunction, an indication for an implantable cardioverter-defibrillator, and mildly symptomatic chronic heart failure. Circulation. 2004; 110(18):2864-8. DOI: 10.1161/01.CIR.0000146336.92331.D1. View

Schach C, Kortl T, Wachter R, Maier L, Sossalla S . Echocardiographic Evaluation of LV Function in Patients with Tachyarrhythmia and Reduced Left Ventricular Function in Response to Rhythm Restoration. J Clin Med. 2021; 10(16). PMC: 8397030. DOI: 10.3390/jcm10163706. View

Nedios S, Sommer P, Dagres N, Kosiuk J, Arya A, Richter S . Long-term follow-up after atrial fibrillation ablation in patients with impaired left ventricular systolic function: the importance of rhythm and rate control. Heart Rhythm. 2013; 11(3):344-51. DOI: 10.1016/j.hrthm.2013.12.031. View

Neumann F, Sousa-Uva M, Ahlsson A, Alfonso F, Banning A, Benedetto U . 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2018; 40(2):87-165. DOI: 10.1093/eurheartj/ehy394. View

Schmidt A, Lauridsen K, Torp P, Bach L, Rickers H, Lofgren B . Maximum-fixed energy shocks for cardioverting atrial fibrillation. Eur Heart J. 2019; 41(5):626-631. DOI: 10.1093/eurheartj/ehz585. View

Huizar J, Ellenbogen K, Tan A, Kaszala K . Arrhythmia-Induced Cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019; 73(18):2328-2344. PMC: 6538508. DOI: 10.1016/j.jacc.2019.02.045. View

10.

Frustaci A, Chimenti C, Bellocci F, Morgante E, Russo M, Maseri A . Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation. 1997; 96(4):1180-4. DOI: 10.1161/01.cir.96.4.1180. View

11.

Gopinathannair R, Etheridge S, Marchlinski F, Spinale F, Lakkireddy D, Olshansky B . Arrhythmia-Induced Cardiomyopathies: Mechanisms, Recognition, and Management. J Am Coll Cardiol. 2015; 66(15):1714-28. PMC: 4733572. DOI: 10.1016/j.jacc.2015.08.038. View

12.

Lawton J, Tamis-Holland J, Bangalore S, Bates E, Beckie T, Bischoff J . 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021; 145(3):e18-e114. DOI: 10.1161/CIR.0000000000001038. View

13.

Nia A, Gassanov N, Dahlem K, Caglayan E, Hellmich M, Erdmann E . Diagnostic accuracy of NT-proBNP ratio (BNP-R) for early diagnosis of tachycardia-mediated cardiomyopathy: a pilot study. Clin Res Cardiol. 2011; 100(10):887-96. DOI: 10.1007/s00392-011-0319-y. View

14.

Bozkurt B, Colvin M, Cook J, Cooper L, Deswal A, Fonarow G . Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association. Circulation. 2016; 134(23):e579-e646. DOI: 10.1161/CIR.0000000000000455. View

15.

Wong M, Staszewsky L, Latini R, Barlera S, Volpi A, Chiang Y . Valsartan benefits left ventricular structure and function in heart failure: Val-HeFT echocardiographic study. J Am Coll Cardiol. 2002; 40(5):970-5. DOI: 10.1016/s0735-1097(02)02063-6. View

16.

Pabel S, Sossalla S . Atrial fibrillation and heart failure: novel insights into the chicken and egg dilemma. Eur Heart J. 2022; 43(36):3376-3378. DOI: 10.1093/eurheartj/ehac257. View

17.

Bozkurt B, Hershberger R, Butler J, Grady K, Heidenreich P, Isler M . 2021 ACC/AHA Key Data Elements and Definitions for Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Heart Failure). Circ Cardiovasc Qual Outcomes. 2021; 14(4):e000102. PMC: 8059763. DOI: 10.1161/HCQ.0000000000000102. View

18.

Saxon L, De Marco T, Schafer J, Chatterjee K, Kumar U, Foster E . Effects of long-term biventricular stimulation for resynchronization on echocardiographic measures of remodeling. Circulation. 2002; 105(11):1304-10. DOI: 10.1161/hc1102.105730. View

19.

Muller-Edenborn B, Minners J, Allgeier J, Burkhardt T, Lehrmann H, Ruile P . Rapid improvement in left ventricular function after sinus rhythm restoration in patients with idiopathic cardiomyopathy and atrial fibrillation. Europace. 2019; 21(6):871-878. DOI: 10.1093/europace/euz013. View

20.

Brembilla-Perrot B, Ferreira J, Manenti V, Sellal J, Olivier A, Villemin T . Predictors and prognostic significance of tachycardiomyopathy: insights from a cohort of 1269 patients undergoing atrial flutter ablation. Eur J Heart Fail. 2016; 18(4):394-401. DOI: 10.1002/ejhf.482. View