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Taquicardiomiopatia: estudo clínico, laboratorial e ecocardiográfico
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Abstract(s)
Contexto: A taquicardiomiopatia representa uma cardiomiopatia parcialmente reversível, secundária a contrações miocárdicas rápidas e/ou assíncronas e irregulares, é caraterizada pela disfunção e insuficiência cardíaca. Encontra-se subestimada e constitui um desafio na prática clínica. A reversibilidade miocárdica sustenta a necessidade de uma rápida atuação. Um tratamento eficaz da disritmia tem melhorias indiscutíveis na função cardíaca e um importante impacto na diminuição da morbilidade, mortalidade e melhoria da qualidade de vida dos doentes. Contudo, é difícil predizer a doença antes do tratamento. Assim, temos por objetivo caraterizar uma população com suspeita de taquicardiomiopatia, avaliar as alterações ocorridas entre os dois momentos de avaliação e identificar preditores de melhoria de prognóstico.
Métodos: Foi realizado um estudo retrospetivo unicêntrico com amostra de base-hospitalar, correspondendo ao universo de doentes com quadro de insuficiência cardíaca com fração de ejeção reduzida e disritmia suspeita de ser a causa precipitante (suspeita de taquicardiomiopatia), entre janeiro de 2019 e dezembro de 2023. Todos os doentes realizaram ecocardiograma transtorácico e análises laboratoriais tanto durante o período de internamento como na consulta de seguimento. Foram definidos dois outcomes principais, a recuperação da fração de ejeção do ventrículo esquerdo e ausência de recidivas.
Resultados: Foram incluídos 54 doentes (idade média de 66 ± 11 anos; 73% masculino), com fibrilhação auricular predominante (81,5%). Na primeira avaliação apresentaram uma frequência cardíaca média de 135,88 ± 31,13bpm, dislipidemia e hipertensão arterial como principais fatores de risco, bem como, depressão da função sistólica esquerda e direita, com fração de ejeção do ventrículo esquerdo média de 30,22 ± 2,02%. No segundo momento de avaliação, observaram-se mudanças significativas (p < 0,05) para a frequência cardíaca, n-terminal pro-peptídeo natriurético tipo B, fração de ejeção do ventrículo esquerdo, espessura do septo interventricular, volume telediastólico da aurícula direita, volume telediastólico do ventrículo esquerdo e S’ tricúspide. Destaca-se melhoria da fração de ejeção do ventrículo esquerdo em 98,15 % dos doentes. Esta variação foi superior a 15% em 75,19% e ocorreram recidivas em 27,8% dos doentes. Os parâmetros estudados não apresentaram efeito preditivo significativo (p-value <0.05) para os indicadores independentes, melhoria de fração de ejeção do ventrículo esquerdo superior a 15% e recidiva.
Conclusão: A taquicardiomiopatia tem um impacto negativo considerável nos parâmetros clínicos, laboratoriais e ecocardiográficos estudados. A cessação disrítmica é fundamental para a recuperação cardíaca por meio de remodeling cardíaco. O estudo e controlo destas variáveis, é indispensável para um diagnóstico eficaz e para predizer um bom prognóstico. Apesar de vários parâmetros serem indicadores de bom prognóstico, neste estudo, não foram encontramos preditores de recuperação da fração de ejeção ou recidiva.
Context: Tachycardiomyopathy is a partially reversible cardiomyopathy secondary to rapid rapid, asynchronous, and irregular myocardial contractions. It is characterized by dysfunction and heart failure. It is often underestimated, and presents a challenge in clinical practice. The myocardial reversibility justifies the need for urgent intervention. Effective treatment of arrhythmia leads to important improvements in cardiac function, significantly reducing morbidity, mortality, and improving patients quality of life. However, predicting the disease before treatment remains difficult. This study aims to characterize a population with suspected tachycardiomyopathy, assess changes between the two evaluation points, and identify predictors of prognosis improvement. Methods: A retrospective single-center study was conducted using a with a hospital-based sample. This compromised all patients with heart failure with reduced ejection fraction and suspected arrhythmia as the precipitating cause (suspected tachycardiomyopathy) between January 2019 and December 2023. All patients underwent transthoracic echocardiography and laboratory tests both during the hospitalization period and at the follow-up appointment. Two outcomes were defined: left ventricular ejection fraction recovery greater than 15% and absence of relapses. Results: The study included 54 patients (mean age 66 ± 11 years; 73% male), with predominant atrial fibrillation (81.5%). At baseline, they had an average heart rate of 135.88 ± 31.13 bpm, with dyslipidemia and hypertension as the main risk factors. Both left and right systolic function were depressed, with a mean left ventricular ejection fraction of 30.22 ± 2.02%. Significant changes (p < 0.05) were observed between the first and second evaluation for heart rate, NT-proBNP, left ventricular ejection fraction, interventricular septal thickness, right atrial end-diastolic volume, left ventricular end-diastolic volume, and tricuspid S'. Left ventricular ejection fraction improvement was observed in 98.15% of patients, with a variation greater than 15% in 75.19%, and recurrences occurred in 27.8% of the sample. The studied parameters did not show significant predictive effects (p < 0.05) for independent indicators of left ventricular ejection fraction improvement greater than 15% or recurrence.Conclusion: Tachycardiomyopathy has a considerable negative impact on the studied clinical, laboratory, and echocardiographic parameters. Arrhythmia cessation is crucial for cardiac recovery through remodeling. Studying and controlling these variables is essential for effective diagnosis and prognosis prediction. While several parameters are considered indicators of a good prognosis, this study did not find significant predictors of tachycardiomyopathy.
Context: Tachycardiomyopathy is a partially reversible cardiomyopathy secondary to rapid rapid, asynchronous, and irregular myocardial contractions. It is characterized by dysfunction and heart failure. It is often underestimated, and presents a challenge in clinical practice. The myocardial reversibility justifies the need for urgent intervention. Effective treatment of arrhythmia leads to important improvements in cardiac function, significantly reducing morbidity, mortality, and improving patients quality of life. However, predicting the disease before treatment remains difficult. This study aims to characterize a population with suspected tachycardiomyopathy, assess changes between the two evaluation points, and identify predictors of prognosis improvement. Methods: A retrospective single-center study was conducted using a with a hospital-based sample. This compromised all patients with heart failure with reduced ejection fraction and suspected arrhythmia as the precipitating cause (suspected tachycardiomyopathy) between January 2019 and December 2023. All patients underwent transthoracic echocardiography and laboratory tests both during the hospitalization period and at the follow-up appointment. Two outcomes were defined: left ventricular ejection fraction recovery greater than 15% and absence of relapses. Results: The study included 54 patients (mean age 66 ± 11 years; 73% male), with predominant atrial fibrillation (81.5%). At baseline, they had an average heart rate of 135.88 ± 31.13 bpm, with dyslipidemia and hypertension as the main risk factors. Both left and right systolic function were depressed, with a mean left ventricular ejection fraction of 30.22 ± 2.02%. Significant changes (p < 0.05) were observed between the first and second evaluation for heart rate, NT-proBNP, left ventricular ejection fraction, interventricular septal thickness, right atrial end-diastolic volume, left ventricular end-diastolic volume, and tricuspid S'. Left ventricular ejection fraction improvement was observed in 98.15% of patients, with a variation greater than 15% in 75.19%, and recurrences occurred in 27.8% of the sample. The studied parameters did not show significant predictive effects (p < 0.05) for independent indicators of left ventricular ejection fraction improvement greater than 15% or recurrence.Conclusion: Tachycardiomyopathy has a considerable negative impact on the studied clinical, laboratory, and echocardiographic parameters. Arrhythmia cessation is crucial for cardiac recovery through remodeling. Studying and controlling these variables is essential for effective diagnosis and prognosis prediction. While several parameters are considered indicators of a good prognosis, this study did not find significant predictors of tachycardiomyopathy.
Description
Keywords
Insuficiência cardíaca Cardiomiopatia Ecocardiograma transtorácico Disfunção ventricular Taquicardiomiopatia Heart failure Cardiomyopathy Transthoracic echocardiography Ventricular dysfunction Tachycardiomyopathy