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Life in the fast lane: clinical and immunohistological characteristics of tachycardia-induced cardiomyopathy—a retrospective study in 684 patients

Leben auf der Überholspur: klinische und immunhistologische Eigenschaften der tachykardieinduzierten Kardiomyopathie – eine retrospektive Studie mit 684 Patienten

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Abstract

Background

Tachycardia-induced cardiomyopathy (TCM) has been known for decades as a reversible form of non-ischemic cardiomyopathy. However, its mechanism and characteristics remain poorly understood.

Objectives

This retrospective study investigated endomyocardial biopsy (EMB) samples from consecutive patients with TCM and compared them with samples from patients with dilated cardiomyopathy (DCM) and inflammatory cardiomyopathy (InCM).

Materials and methods

A total of 684 patients (18 TCM, 170 DCM, 496 InCM) with recent-onset heart failure and reduced ejection fraction unrelated to valvular or ischemic heart disease were analyzed.

Results

In the TCM group, 81% were male, the mean age was 60 ± 13 years, and 94% had heart failure symptoms ≥2 New York Heart Association (NYHA) class. At baseline (BL), 78% had atrial fibrillation/flutter and 12% other forms of tachycardia or frequent extrasystole. The ventricular rate was higher compared to DCM and InCM patients (122 ± 25 versus 78 ± 21; p < 0.001). Mean ejection fraction at BL was lower compared to DCM and InCM (27 ± 12% versus 39.0 ± 14.6%; p = 0.001), but improved to a significantly greater extent during follow-up (FU) (20% versus 6%; p < 0.001). At FU, heart rate and presence of sinus rhythm were similar in all groups; 69% of TCM patients underwent cardioversion or ablation. Compared with DCM patients, TCM patients had stronger myocardial expression of major histocompatibility complex (MHC) class II and an equal amount of infiltration with T‑cells/macrophages. Compared with InCM patients, the presence of T‑cells/macrophages was significantly lower in TCM. The marker of apoptosis (caspase 3) was comparably elevated in TCM/InCM patients.

Conclusion

Tachycardia-induced cardiomyopathy is characterized by immunohistological changes comparable to DCM except for caspase 3 levels, which were similar to those in InCM.

Zusammenfassung

Hintergrund

Die tachykardieinduzierte Kardiomyopathie (TCM) ist seit Jahrzehnten als reversible Form einer nichtischämischen Kardiomyopathie bekannt. Die zugrunde liegenden Mechanismen sind jedoch unzureichend verstanden.

Fragestellung

In dieser retrospektiven Studie wurden Endomyokardbiopsien (EMB) von konsekutiven Patienten mit TCM analysiert und mit EMB von Patienten mit dilatativer (DCM) und inflammatorischer Kardiomyopathie (InCM) verglichen.

Material und Methoden

Untersucht wurden 684 Patienten (18 TCM, 170 DCM, 496 InCM) mit kürzlich aufgetretener Herzinsuffizienz und reduzierter linksventrikulärer Pumpfunktion (LVEF), welche nicht durch Klappenvitien oder myokardiale Ischämie hervorgerufen wurde.

Ergebnisse

In der TCM-Gruppe waren 81 % männlich, das mittlere Alter lag bei 60 ± 13 Jahren, 94 % hatten Herzinsuffizienzsymptome der New-York-Heart-Association(NYHA)-Klasse ≥2. Zur Baseline (BL) hatten 78 % Vorhofflimmern/-flattern und 12 % andere Formen der Tachykardie oder häufige Extrasystolen; die Herzfrequenz war höher im Vergleich zu Patienten mit DCM und InCM (122 ± 25 vs. 78 ± 21; p < 0,001). Die mittlere LVEF zur BL war geringer im Vergleich zu DCM und InCM (27 ± 12 % vs. 39,0 ± 14,6 %; p = 0,001), besserte sich aber signifikant stärker während des Follow-ups (FU; 20 % vs. 6 %; p < 0,001). Zum FU waren die Herzfrequenz und die Häufigkeit eines Sinusrhythmus in allen Gruppen vergleichbar. 69 % der Patienten mit TCM unterzogen sich einer Kardioversion oder Ablationsbehandlung. Verglichen mit DCM-Patienten hatten TCM-Patienten eine ausgeprägtere myokardiale Expression des Haupthistokompatibilitätskomplexes (MHC) Klasse II und ein vergleichbares Ausmaß an Infiltration mit T‑Zellen/Makrophagen. Verglichen mit InCM-Patienten war die Infiltration mit T‑Zellen/Makrophagen bei TCM signifikant geringer. Der Apoptosemarker Caspase 3 war bei Patienten mit TCM bzw. InCM vergleichbar erhöht.

Schlussfolgerung

Die TCM ist charakterisiert durch immunhistologische Veränderungen, die mit denen einer DCM vergleichbar sind, mit Ausnahme des Apoptoseparameters Caspase 3, der mit der InCM vergleichbar ist.

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Authors and Affiliations

  1. Department of Cardiology, Zentralklinik, Robert-Koch-Allee 9, 99437, Bad Berka, Germany

    Adnan Spahic MD

  2. Center for emergency medicine, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany

    Ting-Hui Chen MD

  3. Department of invasive and interventional Electrophysiology, Zentralklinik, Robert-Koch-Allee 9, 99437, Bad Berka, Germany

    J. Christoph Geller MD

  4. Institute of Pathology, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437, Bad Berka, Germany

    Joerg Saenger M.Sc.

  5. Department of Cardiology, SRH Wald-Klinikum, Straße des Friedens 122, 07548, Gera, Germany

    Marc‑Alexander Ohlow MD

Authors
  1. Adnan Spahic MD
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  2. Ting-Hui Chen MD
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  3. J. Christoph Geller MD
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  4. Joerg Saenger M.Sc.
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  5. Marc‑Alexander Ohlow MD
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Corresponding author

Correspondence to Marc‑Alexander Ohlow MD.

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Conflict of interest

A. Spahic, T.‑H. Chen, J.C. Geller, J. Saenger, and M.‑A. Ohlow declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case. This retrospective study was performed after consultation with the institutional ethics committee and in accordance with national legal requirements.

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Spahic, A., Chen, TH., Geller, J.C. et al. Life in the fast lane: clinical and immunohistological characteristics of tachycardia-induced cardiomyopathy—a retrospective study in 684 patients. Herzschr Elektrophys 31, 292–300 (2020). https://doi.org/10.1007/s00399-020-00709-4

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