Usefulness of Ventricular Longitudinal Contractility Assessed by Doppler Tissue Imaging in the Prediction of Reverse Remodeling in Patients with Severe Left Ventricular Systolic Dysfunction

Prediction of left ventricular reverse remodeling after therapy with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers and β blockers in patients with idiopathic dilated cardiomyopathy

Background

Predictors of left ventricular reverse remodeling (LVRR) after therapy with angiotensin converting enzyme inhibitors or angiotensin-receptor blockers and β blockers in patients with idiopathic dilated cardiomyopathy (IDC) remains unclear.

Methods

We studied 44 patients with IDC who had been treated with the therapy. LVRR was defined as LV end-diastolic dimension ≤ 55 mm and fractional shortening ≥ 25% at the last echocardiogram.

Results

During a mean follow-up period of 4.7 ± 3.3 years, LVRR occurred in 34% (15/44) of the patients. We divided the patients into 2 groups: (1) patients with LVRR (n = 15); (2) patients without LVRR (n = 29). The presence of atrial fibrillation was 40% in patients with LVRR and 14% in those without (p = 0.067). Initial LV end-diastolic dimension was significantly smaller (62 ± 6 vs. 67 ± 6 mm, p = 0.033) in patients with LVRR than in those without. Initial LV end-diastolic dimension of 63.5 mm was an optimal cutoff value for predicting LVRR (sensitivity: 67%, specificity: 59%, area under the curve: 0.70, p = 0.030). When patients were further allocated according to initial LV end-diastolic dimension ≤ 63.5 mm with atrial fibrillation, the combined parameter was a significant predictor of LVRR by univariate logistic regression analysis (odds ratio, 5.78, p = 0.030) (sensitivity: 33%, specificity: 97%, p = 0.013).

Conclusions

Combined information on LV end-diastolic dimension and heart rhythm at diagnosis is useful in predicting future LVRR in patients with IDC.

Prediction of short-term outcomes in patients with idiopathic dilated cardiomyopathy referred for transplantation using standard echocardiography and strain imaging

OBJECTIVE

We sought to evaluate the short-term prognostic value of echocardiography including two-dimensional (2D) strain imaging in patients with end-stage idiopathic dilated cardiomyopathy (IDCM).

METHODS

To evaluate the short-term (6-month) prognostic value of different parameters used for the assessment of IDCM patients referred for heart transplantation, we performed at the baseline transthoracic echocardiography including 2D strain imaging, N-terminal pro-BNP measurements, and exercise testing for all patients included in the study. After 6 months, all parameters, including endsystolic strain (ESS), peak systolic strain rate (SSR(max)), early and late diastolic strain rates, their ratio (diastolic strain rate E [DSR(E)], dialostolic strain rate A [DSR(A)], diastolic strain rate E and A wave ratio [DSR(E/A)]), and systolic intraventricular dyssynchrony indexes (IVDSI) were tested for their prognostic value to predict a patient's outcome.

RESULTS

At the baseline stable patients had significantly lower transmitral E and A wave ratio (E/A), DSR(E/A), higher DSR(A) values, longer transmitral E wave deceleration time (DcT), higher longitudinal ESS and SSR(max) values, lower systolic circumferential and longitudinal IVDSI.

CONCLUSION

The highest sensitivity for rapid heart failure progression was shown by DcT <100 ms, E/A > 1.5, DSR(A) < 0.3/s, circumferential IVDSI > 0.16, and longitudinal IVDSI > 0.22 (91%, 78%, 94%, 83%, and 75%, respectively).

Assessment of intraventricular systolic asynchrony in patients with atrial fibrillation using triplane tissue Doppler imaging

BACKGROUND

Triplane tissue Doppler imaging (TDI) makes it possible to simultaneously obtain three apical view images and to measure the dyssynchrony index (DS) for 12 segments in patients with atrial fibrillation (AF). We evaluated the feasibility of using triplane TDI to assess intraventricular asynchrony in AF.

METHODS

In 50 patients with AF, triplane TDI was used for the analysis of myocardial velocity curves of 12 (six basal and six mid) left ventricular (LV) segments by apical two-, three-, and four-chamber views. Time to peak systolic velocity (Ts) was measured, and DS was calculated as the standard deviation (SD) of Ts over 12 segments. The DS(avg) was defined as the average of DS of eight consecutive cycles. To assess the cyclic variability of DS, the coefficient of variation of DS (CoV(DS)) was calculated as the SD of DS for eight cycles divided by DS(avg) [SD(DS)/DS(avg)]. CoV(RR), representing the variability of RR intervals, was defined as [SD(RR)/RR(avg)]. Patients with a left ventricular ejection fraction (LVEF) of 45% or more were classified as group A, and patients with an LVEF less than 45% as were classified as group B.

RESULTS

The mean LVEF was 47% +/- 12%. Group B showed larger LV volume and lower sphericity index compared with group A. Intraobserver and interobserver variability of DS(avg) were 6% and 9%, respectively. More severe dyssynchrony was observed in group B (DS(avg); 23.5 +/- 8.5 ms in group B vs. 17.7 +/- 6.1 ms in group A, P = .008). DS(avg) was not related to RR(avg) or CoV(RR). DS(avg) negatively correlated with ejection fraction (r = -0.404, P = .004) and sphericity index (r = -0.317, P = .025) and showed positive correlation with LV volume.

CONCLUSION

Analysis of asynchrony by triplane TDI was feasible in patients with AF. DS(avg) correlated with echocardiographic parameters of systolic function.