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Long-term prognosis of pure and impure tachycardiomyopathy
Giulia Stronati1,2, Michele Alfieri1,2, Niki Tombolesi1
1Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Marche University Hospital, Ancona, Italy.
Insights
Tachycardia-induced cardiomyopathy (TCM) offers good survival but high readmission rates, requiring early rhythm control. Early recognition of arrhythmias is key for managing heart failure (HF) and improving outcomes.
Area of Science:
- Cardiology
- Heart Failure Research
- Arrhythmia Management
Background:
- Tachycardia-induced cardiomyopathy (TCM) is a reversible heart failure (HF) cause, often linked to atrial fibrillation (AF).
- Long-term prognosis of TCM compared to other HF with reduced ejection fraction (HFrEF) causes is not well-defined.
- This study compares the prognosis of pure and impure TCM with other HFrEF etiologies.
Purpose of the Study:
- To evaluate and compare the long-term prognosis of tachycardia-induced cardiomyopathy (TCM) against other causes of heart failure with reduced ejection fraction (HFrEF).
- To assess the impact of rhythm control strategies on survival and hospital readmissions in TCM patients.
- To identify key factors influencing outcomes in patients with de novo, acute decompensated HFrEF.
Main Methods:
- A prospective, observational study included 456 patients hospitalized with de novo, acute decompensated HFrEF.
- Patients were categorized into four groups: pure TCM, impure TCM, ischemic HF, and non-ischemic HF.
- Primary endpoint was all-cause mortality; secondary endpoint was unplanned cardiovascular hospitalizations, with propensity score matching for sensitivity analyses.
Main Results:
- Pure TCM demonstrated the highest survival rate (78.2%) over 3 years, while ischemic HF had the lowest (58.5%).
- TCM groups exhibited the lowest rates of freedom from readmission (pure TCM 43.2%, impure TCM 60.0%) compared to non-ischemic HF (83.2%) and ischemic HF (69.9%).
- An initial rhythm control strategy was linked to improved survival in TCM (79% vs. 63%) but did not significantly alter readmission rates.
Conclusions:
- Pure TCM has a favorable survival prognosis but is associated with high readmission rates, necessitating diligent arrhythmia monitoring and management.
- Early rhythm control strategies appear to improve survival in TCM patients.
- Prompt identification of arrhythmias as a cause of HF exacerbation is crucial for effective patient management and improved long-term outcomes.
Background And Aims:
Tachycardia-induced cardiomyopathy (TCM) is a reversible form of heart failure (HF) driven by arrhythmias, often atrial fibrillation (AF). While reversible, TCM's long-term prognosis remains unclear, especially in comparison to HF with reduced ejection fraction (HFrEF). This study examines the prognosis of pure and impure TCM against other causes of HFrEF.
Methods:
Prospective, monocentric, observational study of 456 patients hospitalized with de novo, acute decompensated HFrEF, classified into pure TCM, impure TCM, ischaemic HF and non-ischaemic HF. The primary endpoint was all-cause mortality, and the secondary endpoint was the incidence of unplanned cardiovascular hospitalisations. Sensitivity analyses were performed using propensity score matching between the four groups.
Results:
During a median follow-up of 3 years (interquartile range 1.5-5.1 years), pure TCM had the highest survival rate, and ischaemic HF had the lowest (pure TCM 78.2%; impure TCM 64.8%; non-ischaemic HF 73.4%; ischaemic HF 58.5%; log-rank P < 0.0001). Pure and impure TCM presented the lowest free-from-readmission estimates over follow-up (pure TCM 43.2%; impure TCM 60.0%; non-ischaemic HF 83.2%; ischaemic HF 69.9%; log-rank P < 0.0001). An initial rhythm control strategy was associated with better overall survival in TCM (79% vs. 63%; log-rank P < 0.0001) but similar rates of unplanned hospitalization.
Conclusions:
Pure TCM shows a favourable survival prognosis but high readmission rates, emphasizing the need for early rhythm control and sustained monitoring for arrhythmia recurrence. An initial rhythm control strategy seems associated with an increased survival, highlighting the importance of early recognition of arrhythmias as a culprit of HF worsening.
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