Author + information
- Received February 18, 2016
- Revision received March 21, 2016
- Accepted March 31, 2016
- Published online February 6, 2017.
- Kenya Kusunose, MD, PhDa,
- Yuta Torii, RMSb,
- Hirotsugu Yamada, MD, PhDa,∗ (, )
- Susumu Nishio, RMSb,
- Yukina Hirata, RMS, PhDb,
- Hiromitsu Seno, MDa,
- Yoshihito Saijo, MDa,
- Takayuki Ise, MD, PhDa,
- Koji Yamaguchi, MD, PhDa,
- Takeshi Tobiume, MDa,
- Shusuke Yagi, MD, PhDa,
- Takeshi Soeki, MD, PhDa,
- Tetsuzo Wakatsuki, MD, PhDa and
- Masataka Sata, MD, PhDa
- aDepartment of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
- bUltrasound Examination Center, Tokushima University Hospital, Tokushima, Japan
- ↵∗Address for correspondence:
Dr. Hirotsugu Yamada, Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, Japan 770-8503.
Objectives This study sought to assess the time course of presumptive tachycardia-induced cardiomyopathy and the predictors of left ventricular (LV) functional recovery in such patients.
Background Tachycardia-induced cardiomyopathy is a potentially reversible cardiomyopathy with effective treatment of the tachyarrhythmia. However, cases without improvement of LV systolic function were found occasionally. The diagnosis of tachycardia-induced cardiomyopathy can be challenging, and the role of echocardiographic imaging in the prediction of LV functional recovery is limited.
Methods LV segmental longitudinal strains (LS) were evaluated by 2-dimensional speckle tracking in 71 consecutive patients (65 ± 16 years; 61% men) with tachyarrhythmia and reduced left ventricular ejection fraction (LVEF) without any other known cardiovascular disease, and 30 age and sex-matched control subjects. Relative apical LS ratio (RALSR) was defined using the equation: average apical LS / (average basal LS + average mid LS) as a marker of strain distribution.
Results Compared with control subjects, patients with tachyarrhythmia had significantly lower global LS. Improvement in LVEF within 6 months after treatment of index arrhythmia was observed in 41 patients, and LVEF did not improve in 30 patients. In univariate analysis, lower LVEF at baseline (hazard ratio: 0.59 per 1 SD; p = 0.04) and higher RALSR (hazard ratio: 11.2 per 1 SD; p < 0.001) were associated with no recovery in LVEF during follow-up. In a multivariate logistic regression model, the significant predictor of LV systolic functional recovery was RALSR (hazard ratio: 22.9 per 1 SD; p = 0.001). A RALSR of 0.61 was sensitive (71%) and specific (90%) in differentiating LV systolic functional recovery (area under the curve: 0.88).
Conclusions The RALSR was associated with LV systolic functional recovery. This information might be useful for clinical evaluation and follow-up in patients with reduced LVEF.
This work was partially supported by JSPS Kakenhi (grant 15K19381 to Dr. Kusunose; and 24659392, 22390159, 25670390, and 25293184 to Dr. Sata), Japan Heart Foundation Research (Dr. Kusunose), and MEXT KAKENHI (grant 21117007 to Dr. Sata). All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 18, 2016.
- Revision received March 21, 2016.
- Accepted March 31, 2016.
- American College of Cardiology Foundation