P1353 Left ventricular performance patterns in patients with dilated cardiomyopathy and advanced heart failure

Background

Left ventricular (LV) global longitudinal strain (GLS) is a more sensitive parameter than ejection fraction in the assessment of LV function. It has been established as a predictor of cardiac death and adverse events. In patients with dilated cardiomyopathy (DCM) LV deformation and twist mechanics are reduced in varying degrees.

Purpose

The aim of the study was to determine different LV performance patterns in patients with DCM and advanced heart failure (HF).

Methods

In 52 patients with DCM with HF NYHA class III-IV (62 ± 13 years, 36 males) LV function had been assessed by conventional, Tissue Doppler and 2D-speckle tracking echocardiography (2D-STE) with measurement of GLS, circumferential strain (CS) and twist mechanics. Patients were divided into two groups: with GLS≥-7 %, and GLS<-7 %.

Results

In a group with more reduced GLS≥-7% systolic parameters were worse, Table. Systolic velocities of medial and lateral mitral annulus (S’lat), and CS at the LV basal and mid levels (CSmid) were significantly more altered. Rotational parameters did not differ between the groups. In a multivariate regression model CSmid (p < 0.0001; B = 0.66, 95%CI [0.37 ÷ 0.95]), S’lat (p = 0.001; B=-0.34, 95%CI [-1.5÷-0.46]) and VCW (p = 0.002; B = 0.31, 95%CI [0.15 ÷ 0.66]) were independent predictors of GLS. ROC curves identified CSmid (AUC 0.91, p < 0.0001) and VCW (AUC 0.69, p = 0.02) as the best discriminators of patients with severely reduced GLS≥-7%.

Conclusions

Patients with DCM and HF with severely depressed LV function assessed by GLS were characterized with more altered CS and more pronounced MR. Rotational parameters failed to be significant determinants of LV performance.

Echocardiographic parameters GLS≥-7% N = 24 GLS<-7% N = 28 p End diastolic volume index(ml/m²) 113.55 ± 41.64 87.98 ± 26.98 0.01 End systolic volume index(ml/m²) 84.50 ± 39.05 55.51 ± 21.93 0.001 Ejection fraction (%) 28 ± 8 35 ± 7 0.001 Systolic velocity of medial mitral annulus (cm/sec) 3.57 ± 0.81 4.88 ± 1.52 0.001 Systolic velocity of lateral mitral annulus (cm/sec) 4.38 ± 1.09 5.38 ± 1.42 0.014 Circumferential strain at basal level (%) -5.92 ± 3.15 55.52 ± 21.93 0.014 Circumferential strain at mid-level (%) -5.11 ± 1.77 -8.71 ± 2.34 <0.0001 Epicardial Torsion (°/cm) 0.31 ± 0.18 0.47 ± 0.35 0.05 Vena contracta width of mitral regurgitation (mm) 7.34 ± 2.23 5.58 ± 2.82 0.017 GLS - global longitudinal strain.