Management of Tachycardia-Mediated Cardiomyopathy: Experience from the Vancouver General Hospital Cardiac Function Clinic (TMC-EXPLOR Study).

Background: Tachycardia-mediated cardiomyopathy (TMC) is a reversible form of heart failure with reduced ejection fraction (HFrEF), most commonly caused by atrial fibrillation or atrial flutter. Evidence for its management is scarce, and practice patterns are highly variable. Objective: To describe management patterns for HFrEF and atrial arrhythmias in patients with TMC at a specialty heart failure clinic. Methods: This retrospective cohort study involved adults with HFrEF and a physician-determined diagnosis of TMC, with an initial visit for this problem between October 2018 and October 2019. The 2 primary outcomes, evaluated at 1 year after the initial visit, were the proportion of patients receiving triple therapy (combination of angiotensin receptor-neprilysin inhibitor [or angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker if ejection fraction improved to > 40% by 1 year], ß-blocker, and mineralocorticoid receptor antagonist at any dose) and the proportion receiving or with a plan to receive rhythm control. Results: A total of 59 participants met the inclusion criteria. The mean age was 73 years, 39 patients (66%) were male, and 42 (71%) had hypertension. At 1-year follow-up, 42 (71%) were receiving triple therapy, and rhythm control was attempted or planned for 20 (34%). Among the 17 patients (29%) not receiving triple therapy, a mineralocorticoid receptor antagonist was the agent most commonly omitted. Conclusions: In a specialty heart failure clinic, most patients with TMC were receiving triple therapy, with a mineralocorticoid receptor antagonist being the agent most commonly missing among those not receiving triple therapy. One-third of patients with TMC had received a rhythm-control strategy. These gaps in HFrEF therapy and rhythm control represent key areas for quality improvement initiatives in the management of patients with TMC.

Contexte: La cardiomyopathie rythmique (CMR) est une forme réversible d'insuffisance cardiaque à fraction d'éjection réduite (HFrEF), le plus souvent causée par la fibrillation auriculaire ou le flutter auriculaire. Les données probantes relatives à sa prise en charge sont rares et les modèles de pratique sont très variables. Objectif: Décrire les schémas de prise en charge de l'HFrEF et des arythmies auriculaires chez les patients atteints d'une CMR dans une clinique spécialisée en insuffisance cardiaque. Méthodes: Cette étude de cohorte rétrospective impliquait des adultes atteints d'HFrEF et ayant reçu un diagnostic de CMR déterminé par un médecin, avec une première visite pour ce problème de santé entre octobre 2018 et octobre 2019. Les 2 résultats principaux, évalués 1 an après la première visite, étaient les suivants: 1) la proportion de patients recevant une trithérapie (association récepteur de l'angiotensine-néprilysine (ARNi) [ou inhibiteur de l'enzyme de conversion de l'angiotensine/antagoniste des récepteurs de l'angiotensine II si la fraction d'éjection s'est améliorée à > 40 % à 1 an], un traitement par ß-bloquant et un antagoniste des récepteurs des minéralocorticoïdes à n'importe quelle dose); et 2) la proportion recevant ou prévoyant de recevoir un médicament antiarythmique. Résultats: Au total, 59 participants répondaient aux critères d'inclusion. L'âge moyen était de 73 ans; 39 patients (66 %) étaient des hommes et 42 (71 %) avaient de l'hypertension. Au marqueur d'un an, 42 (71 %) recevaient une trithérapie et un médicament antiarythmique a été tenté ou était prévu pour 20 (34 %) patients. Parmi les 17 patients (29 %) ne recevant pas de trithérapie, l'agent le plus souvent omis était l'antagoniste des récepteurs des minéralocorticoïdes. Conclusions: Dans une clinique spécialisée dans l'insuffisance cardiaque, la plupart des patients atteints d'une CMR recevaient une trithérapie, l'antagoniste des récepteurs minéralocorticoïdes étant l'agent le plus souvent absent chez ceux qui n'en recevaient pas. Un tiers des patients atteints d'une CMR avaient reçu un médicament antiarythmique. Ces lacunes concernant la thérapie HFrEF et la gestion de l'arythmie représentent des domaines clés pour les initiatives d'amélioration de la qualité dans la prise en charge des patients atteints d'une CMR.

Interaction of Gender and Hepatitis C in Risk of Chronic Renal Failure After Liver Transplantation

ABSTRACT Background. Chronic renal failure (CRF) is a significant cause of morbidity and mortality in post-liver transplantation (LT) recipients. The risk factors associated with the development of renal dysfunction are not clearly elucidated. Objectives. To examine the risk factors in the development of CRF in these patients. Material and methods. Retrospective case-cohort of liver transplant patients without baseline kidney dysfunction who developed chronic renal failure during their follow-up. Results. Of 370 patients, 254 met the inclusion criteria. 30% (76) of these patients had CRF of which 57% (43) were male. Age, estimated glomerular filtration rate (eGFR) at discharge, and HCV infection were found to be risk factors for CRF post-LT. The odds ratio of developing CRF was 1.4 (0.6-3.3) in males with HCV, 1.6 (0.7-3.9) in females without HCV and 4.4 (1.5-13.2) among females with HCV when compared to men without HCV. Conclusions. In this cohort of LT receipients of a major Canadian city, age, eGFR, and HCV infection were risk factors for CRF. Female gender and HCV increased this odds by a factor of more than 4.

Interaction of Gender and Hepatitis C in Risk of Chronic Renal Failure After Liver Transplantation.

BACKGROUND: Chronic renal failure (CRF) is a significant cause of morbidity and mortality in post-liver transplantation (LT) recipients. The risk factors associated with the development of renal dysfunction are not clearly elucidated. OBJECTIVES: To examine the risk factors in the development of CRF in these patients. MATERIAL AND METHODS: Retrospective case-cohort of liver transplant patients without baseline kidney dysfunction who developed chronic renal failure during their follow-up. RESULTS: Of 370 patients, 254 met the inclusion criteria. 30% (76) of these patients had CRF of which 57% (43) were male. Age, estimated glomerular filtration rate (eGFR) at discharge, and HCV infection were found to be risk factors for CRF post-LT. The odds ratio of developing CRF was 1.4 (0.6-3.3) in males with HCV, 1.6 (0.7-3.9) in females without HCV and 4.4 (1.5-13.2) among females with HCV when compared to men without HCV. CONCLUSIONS: In this cohort of LT receipients of a major Canadian city, age, eGFR, and HCV infection were risk factors for CRF. Female gender and HCV increased this odds by a factor of more than 4.