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Left ventricular reverse remodeling in dilated cardiomyopathy- maintained subclinical myocardial systolic and diastolic dysfunction.
- Source :
-
The international journal of cardiovascular imaging [Int J Cardiovasc Imaging] 2017 May; Vol. 33 (5), pp. 605-613. Date of Electronic Publication: 2016 Dec 24. - Publication Year :
- 2017
-
Abstract
- In idiopathic dilated cardiomyopathy (DCM), myocardial deformational parameters and their relationships remain incompletely characterized. We measured those parameters in patients with DCM, during left ventricular reverse remodeling (LVRR). Prospective study of 50 DCM patients (in sinus rhythm), with left ventricular ejection fraction (EF) <40%. LVRR was defined as an increase of ten units of EF and decrease of diastolic left ventricular diameter (LVDD) in the absence of resynchronization therapy. Performed morphological analysis, myocardial performance quantification (LV and RV Tei indexes) and LV averaged peak systolic longitudinal strain (SSR long) and circumferential strain (SSR circ). At baseline, mean EF was 25.4 ± 9.8%, LVDD was 62.4 ± 7.4 mm, LVDD/BSA of 34.2 ± 4.5 mm/m <superscript>2</superscript> and 34% had MR grade >II/IV. LVRR occurred in 34% of patients within 17.6 ± 15.6 months and was associated with a reduced rate of death or heart failure hospitalization (5.9% vs. 33.3; p = 0.03). Patients with LVRR had a final EF of 48.9 ± 7.9% (Δ LV EF of 22.4%) and there was a significant decrease (p < 0.05) in: LVDD/BSA, LV systolic diameter/BSA, LV diastolic volume, LV systolic volume, LV mass; an increase (p < 0.05) in sphericity index. However, measures of diastolic function (LA volume/BSA, e'velocity and' E/e'ratio), final LV and RV Tei indexes were not significantly different from baseline. Additionally, final SSR circ and SSR long values were not different from basal. Patients who recovered EF >50% (n = 10), SSR circ and SSR long were inferior to normal. Improvement in EF occurred in one-third of DCM pts and was associated with a decrease of major cardiac events. There was an improvement of diastolic and systolic volumes and in sphericity index, confirming truly LV reverse reshaping. However, myocardial performance indexes, SSR long and SSR circ in reverse-remodeled DCM were still abnormal, suggesting a maintained myocardial systolic and diastolic dysfunction.
- Subjects :
- Adult
Aged
Cardiomyopathy, Dilated complications
Cardiomyopathy, Dilated diagnostic imaging
Cardiomyopathy, Dilated drug therapy
Cardiovascular Agents therapeutic use
Diastole
Disease Progression
Echocardiography, Doppler, Pulsed
Female
Heart Failure diagnosis
Heart Failure etiology
Heart Failure prevention & control
Humans
Male
Middle Aged
Prospective Studies
Recovery of Function
Stroke Volume
Systole
Treatment Outcome
Ventricular Dysfunction, Left diagnostic imaging
Ventricular Dysfunction, Left drug therapy
Ventricular Dysfunction, Left etiology
Cardiomyopathy, Dilated physiopathology
Heart Failure physiopathology
Ventricular Dysfunction, Left physiopathology
Ventricular Function, Left drug effects
Ventricular Remodeling drug effects
Subjects
Details
- Language :
- English
- ISSN :
- 1875-8312
- Volume :
- 33
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- The international journal of cardiovascular imaging
- Publication Type :
- Academic Journal
- Accession number :
- 28013418
- Full Text :
- https://doi.org/10.1007/s10554-016-1042-6