Electrocardiogram and CMR to differentiate tachycardia-induced cardiomyopathy from dilated cardiomyopathy in patients admitted for heart failure

Emerging concepts in heart failure management and treatment: focus on tachycardia-induced cardiomyopathy

“…Patients with DCM showed wider QRS (121.2±26 versus 97.7±17.35 ms; p =0.003) with a more frequent presence of late gadolinium enhancement (61 versus 16%; p =0.004) whereas LVEF was higher in the TCMP group (33.4±11 versus 26.9±6.4%; p =0.019). 37 A QRS duration ≥100 ms ( p =0.027), LVEF <40% ( p =0.047) and presence of late gadolinium enhancement ( p =0.03) were independent predictors of lack of LVEF recovery (multivariate analysis), whilst, through follow-up (median 60 months), patients with DCM were hospitalized more frequently for HF (44 versus , 0%; p <0.001) than were patients with TCMP. 37 …”

“… 37 A QRS duration ≥100 ms ( p =0.027), LVEF <40% ( p =0.047) and presence of late gadolinium enhancement ( p =0.03) were independent predictors of lack of LVEF recovery (multivariate analysis), whilst, through follow-up (median 60 months), patients with DCM were hospitalized more frequently for HF (44 versus , 0%; p <0.001) than were patients with TCMP. 37 …”

“… 38 The role of the electrocardiogram and cardiac magnetic resonance in patients admitted for HF with a concomitant supraventricular tachyarrhythmia was assessed by Vera et al comparing TCMP versus other forms of DCM. 37 A total of 43 consecutive individuals with LVEF <50% were analysed; those treated who achieved LVEF >50% during follow-up were classified as TCMP (58%), whilst those (despite receiving treatment) who remained with LVEF <50% were estimated as DCM. Patients with DCM showed wider QRS (121.2±26 versus 97.7±17.35 ms; p =0.003) with a more frequent presence of late gadolinium enhancement (61 versus 16%; p =0.004) whereas LVEF was higher in the TCMP group (33.4±11 versus 26.9±6.4%; p =0.019).…”

“… 6 The usual imaging techniques (echocardiography or cardiac magnetic resonance) reveal the presence of dilated cardiomyopathy with moderate to severe impaired LVEF, absence of myocardial hypertrophy and functional mitral regurgitation. 1 , 36 , 37 Holter monitoring for 24 hours (or even longer) may be useful in diagnosing frequent paroxysmal cases of tachycardiomyopathy or in checking for a sustained increase in HR. 1…”

“…The main diagnostic challenge is differentiating TCMP from non-ischaemic dilated cardiomyopathy (DCM) 2 and, compared with this, patients with TCMP usually have (at diagnosis) a higher HR and lower LVEF but with greater LVEF recovery during follow-up (after HR normalization). 37 On the other hand, patients with DCM tend to have wider QRS complexes, more frequent late gadolinium enhancement (cardiac magnetic resonance) and more rehospitalizations during follow-up. 38 From a histopathological and immunological perspective (right ventricular biopsies), TCMP is characterized by ( versus non-ischaemic/non-valvular DCM) 39 stronger myocardial expression of the major histocompatibility complex class II molecule; particularly potent infiltration of CD68 + macrophages; a general lower presence of T cells and macrophages; increased myocyte size and a lower extent of myocardial fibrosis; and more altered distribution of mitochondrial pattern.…”