title: Predictors of left ventricular systolic function recovery in the setting of sinus tachycardia in patients with cancer.
abstract: OBJECTIVE
  To identify unique echocardiographic features that could be used to reliably predict LVEF recovery upon resolution of sinus tachycardia in patients with cancer.
  
  
  BACKGROUND
  Sinus tachycardia may be a manifestation of underlying cardiomyopathy or can lead to a reversible form of dilated cardiomyopathy known as tachycardia-mediated cardiomyopathy. While distinguishing the two can be challenging, predicting recovery regardless of cause can be of significant clinical importance in the cancer population.
  
  
  METHODS
  Results of echocardiograms performed were collected. Patients with a repeat echocardiogram within 6 months of the initial echocardiogram were included. Patients with structural heart disease, acute coronary syndrome, sepsis, and pericardial disease were excluded. A comparison between baseline echocardiogram and subsequent echocardiogram was made to determine whether specific echocardiographic parameters predicted LVEF recovery. Two groups of patients were defined at the outset of the study. The recovered group was comprised of patients with reduced LVEF in the setting of sinus tachycardia and normal LVEF with resolution of tachycardia to normal sinus rhythm (NSR). The unrecovered group was comprised of subjects with low LVEF in the setting of both sinus tachycardia and NSR.
  
  
  RESULTS
  A total of 40 patients were included in the study. LVEF in the recovered group (n=18) was 42.8% with sinus tachycardia and increased to 58.3% with NSR. Average LVEF in the unrecovered group (n=22) was 35.1% with tachycardia and improved to 38.5% with NSR. Medial TDI (E') was significantly greater in the recovered group with both tachycardia (7.95 cm/s versus 4.56 cm/s, P<.001) and NSR (8.11 cm/s versus 5.13 cm/s, P<.001). Similarly, lateral TDI (E') was significantly greater in the recovered group than in the unrecovered group during tachycardia (8.97 cm/s versus 5.13 cm/s, P<.001) and NSR (9.05 cm/s versus 5.13 cm/s, P<.001). Multivariable logistic regression analysis showed that medial TDI >6.5 cm/s (OR=30.9, P=.001) and lateral TDI >7.8 cm/s (OR=52.5, P=.002) are positively associated with the probability of LVEF recovery.
  
  
  CONCLUSIONS
  In conclusion, TDI (medial E'>6.5 cm/s; lateral E'>7.8 cm/s) appears to predict LVEF recovery in patients with sinus tachycardia upon resolution of the tachycardia in patients with cancer.
authors: Department of Cardiology, Division of Medicine, MD Anderson Cancer Center, Houston, Texas.
authors: Saamir A
authors: SA
authors: Hassan
authors: Department of Cardiology, Division of Medicine, MD Anderson Cancer Center, Houston, Texas.
authors: Syed Wamique
authors: SW
authors: Yusuf
authors: Division of Cardiology, Department of Medicine, University of Texas Health Science Center, Houston, Texas.
authors: Jyoti
authors: J
authors: Sharma
authors: Division of Cardiology, Department of Medicine, University of Texas Health Science Center, Houston, Texas.
authors: Jasmine
authors: J
authors: Khan
authors: Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas.
authors: Michele
authors: M
authors: Guindani
authors: Department of Cardiology, Division of Medicine, MD Anderson Cancer Center, Houston, Texas.
authors: Vicente
authors: V
authors: Valero
authors: Department of Cardiology, Division of Medicine, MD Anderson Cancer Center, Houston, Texas.
authors: Mariana
authors: M
authors: Chavez-McGregor
authors: Department of Cardiology, Division of Medicine, MD Anderson Cancer Center, Houston, Texas.
authors: Jose
authors: J
authors: Banchs
mesh_terms: D009202:Cardiomyopathies / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D011379:Prognosis; D020127:Recovery of Function; D013318:Stroke Volume / Q000502:physiology; D013599:Systole; D013616:Tachycardia, Sinus / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: cancer; cardiomyopathy; diastolic function; sinus tachycardia