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Updated: Jun 4, 2025
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Guideline-directed medical therapy for heart failure in arrhythmia-induced cardiomyopathy with improved left
Luis Manuel Domínguez-Rodríguez1,2,3, David Dobarro4, Carla Iglesias-Otero4
1Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Insights
Guideline-directed medical therapy, including RAS inhibitors and beta-blockers, significantly reduces heart failure relapse in patients with arrhythmia-induced cardiomyopathy and improved ejection fraction. This therapy is crucial for preventing readmissions and maintaining cardiac function.
Area of Science:
- Cardiology
- Heart Failure Research
- Clinical Medicine
Background:
- Arrhythmia-induced cardiomyopathy (AiCM) is a significant cause of heart failure (HF).
- The impact of guideline-directed medical therapy (GDMT) on HF relapse in AiCM patients with improved left ventricular ejection fraction (LVEF) remains understudied.
- Understanding relapse prevention is critical for managing patients with AiCM.
Purpose of the Study:
- To analyze the effectiveness of GDMT in preventing HF relapse in patients with AiCM after LVEF improvement.
- To identify specific GDMT components associated with reduced relapse rates.
- To provide evidence for optimizing treatment strategies in AiCM.
Main Methods:
- Retrospective analysis of a single-center cohort of 200 HF patients with AiCM and LVEF <50%.
- Primary endpoint: time to HF relapse (HF readmission, ED visit for HF, or significant LVEF decline).
- Time-varying multivariate Cox regression analysis to assess medication impact.
Main Results:
- Among 188 confirmed AiCM patients, 47.3% experienced HF relapse.
- RAS inhibitors (aHR 0.50) and beta-blockers (aHR 0.48) were significantly associated with lower relapse incidence.
- Mineralocorticoid receptor antagonists reduced ED visits for HF but not the primary endpoint.
Conclusions:
- Maintaining RAS inhibitors and beta-blockers is associated with significantly lower HF relapse rates in AiCM patients with improved LVEF.
- These findings support the continued use of specific GDMT components for relapse prevention in AiCM.
- Further research may explore optimal combination therapies for AiCM management.
Aims:
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.
Methods And Results:
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.
Conclusion:
Maintaining RAS inhibitors and beta-blockers was associated with a significantly lower incidence of relapse in the setting of AiCM with improved LVEF.
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