Abstract 14688: Paradox of Right Ventricular Function: Lower the Better? -- Right Ventricular Dysfunction May Predict the Diagnosis of Tachycardia Induced Cardiomyopathy
Background: Differentiating tachycardia induced cardiomyopathy (TIC) from other dilated cardiomyopathies (DCM) remains challenging in patients presenting with LV dysfunction and AF tachycardia. While sustained rapid pacing in animals produces biventricular dysfunction, left-sided heart failure patients develop right ventricular (RV) dysfunction in advanced stages following increase in pulmonary vascular resistance. We hypothesized that RV dysfunction at presentation may predict the diagnosis of TIC.
Methods: We studied the RV function using CMR in 102 consecutive patients with LVEF<45% and uncontrolled AF tachycardia (defined as heart rate over 100 at rest or over 160 on exercise). Patients with coronary, valvular, congenital, or other secondary cardiomyopathies were not included. CMR was performed after heart rate stabilization, and ventricular functions assessed by Argus (Siemens, Germany), endomyocardial biopsies and hemodynamic data from Swan-Ganz catheter were analyzed. Patients who had normal EF after 1 year treatment were classified as TIC group (n=45), and patients who did not as DCM group (n=57).
Results: LVEF at presentation by echocardiogram were similar between the 2 groups (29.2±9.7 vs.28.1±8.0%, p=0.79). At CMR, TIC group had higher LVEF (33.5±9.8 vs. 24.8±7.6%, p<0.001) but tended to have lower RVEF (33.0±7.4 vs. 35.0±6.7%, p=0.11). No significant differences were observed between TIC and DCM in myocardial fibrosis, hypertrophy or hemodynamic parameters including pulmonary vascular resistance. RVEF/LVEF ratio was significantly lower in TIC (1.03±0.25 vs. 1.51±0.45, p<0.001), and by ROC analysis, RVEF/LVEF ratio<1.1 predicted TIC with a sensitivity of 76% and specificity of 87% (AUC=0.85). Logistic regression analysis showed RVEF/LVEF ratio is a strong independent predictor of TIC (OR=0.62 per 0.1, p<0.001).
Conclusions: RV dysfunction assessed by RVEF/LVEF ratio was highly predictive of TIC. Ventricular impairment in TIC occurs equally in both ventricles, and RV dysfunction in TIC develops without elevation of pulmonary vascular resistance. While RV dysfunction generally indicates advanced heart failure with worse prognosis, it may also indicate TIC, which is generally considered to have good prognosis.
Author Disclosures: A. Okada: None. I. Nakajima: None. Y. Morita: None. T. Kamakura: None. M. Wada: None. K. Ishibashi: None. K. Miyamoto: None. S. Nagase: None. T. Noda: None. T. Aiba: None. S. Kamakura: None. T. Anzai: None. T. Noguchi: None. S. Yasuda: None. H. Ogawa: Other Research Support; Modest; Astellas Pharma Inc, Bristol-Myers Squibb Company, Chugai Pharmaceutical Co, Ltd., Dainippon Sumitomo Pharma Co., Ltd., MSD K.K., Mochida Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., Otsuka, Pfizer Japan Inc, Takeda Pharmaceutical Co., Ltd.. Other Research Support; Significant; Bayer, Daiichi Sankyo Co.Ltd, Novartis Pharma K.K., Sanofi K.K. Honoraria; Modest; AstraZeneca K.K.. Ltd, Boehringer Ingelheim Japan, Bristol-Myers Squibb Company, Mitsubishi Tanabe Pharma, Pfizer Japan Inc, Sanofi K.K., Teijin Pharma Co. Honoraria; Significant; Bayer Yakuhin, Ltd., Daiichi Sankyo Co. Ltd, MSD K.K., Takeda Pharmaceutical Co. Ltd.. K.F. Kusano: None.
- © 2015 by American Heart Association, Inc.