Left ventricular reverse remodeling in dilated cardiomyopathy- maintained subclinical myocardial systolic and diastolic dysfunction

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 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.

Prognostic Relevance of Left Ventricular Myocardial Performance After Transcatheter Aortic Valve Replacement

“…The LV Tei index is an established echocardiographic parameter of advanced heart disease and a wellknown predictor of worse clinical outcomes among patients with different types of cardiomyopathy, including ischemic, dilated, or hypertrophic heart disease. 8,9 Furthermore, LV Tei is effective in the early detection of subclinical ventricular dysfunction in patients with insulin resistance 13 and is used as early reference marker for hypertensive cardiomyopathy in children with essential hypertension. 14 However, it lacks precision and reproducibility in patients with atrial fibrillation, pacemaker rhythm, frequent ventricular ectopic stimuli, and disturbances of intraventricular or atrioventricular conduction.…”

“…[4][5][6] The myocardial performance index Tei is recognized as echocardiographic parameter to determine overall cardiac performance and express global systolic and diastolic ventricular function. 7 While the prognostic value of Tei has been studied in patients with congestive heart failure and dilated cardiomyopathy, 8,9 the diagnostic and prognostic role of Tei in patients with severe AS undergoing TAVR remains to be elucidated.…”

Clinical significance of early‐diastolic tissue velocity imaging of lateral mitral annulus for prognosis of nonischemic left ventricular dysfunction

“…Moreover, the Kaplan-Meier analysis revealed that the clinical outcomes in cases of low TVI occurred much more frequently within 1.0 to 1.5 years, which usually fell within the time to LVEF recovery. 29,30 The present study has several limitations. First, a fully automated quantitative analysis of scar burden or total LGE was not performed.…”

“…Based on the current study's findings, the association between a Lat‐e′ of >7.8 cm/s and reversibility could account for the LGE (−) site, but Sep‐e′ did not show such a relationship. Moreover, the Kaplan‐Meier analysis revealed that the clinical outcomes in cases of low TVI occurred much more frequently within 1.0 to 1.5 years, which usually fell within the time to LVEF recovery …”

Left Ventricular Mechanical Reverse Remodelling Not Followed by Electrical Reverse Remodelling: A Case Report

“…In a study on patients with recovered LV function, subclinical LV dysfunction was observed at rest and during exercise [5]. Also, in a previously published study [6], in some patients whose LVEF had improved to normal values, measures of diastolic function, the myocardial performance index, and circumferential and longitudinal systolic strain rates were still impaired. We may therefore speculate that decreases in certain regional strain and strain rate parameters may be compensated by increases in other kinds of strain (e.g., radial strain) or LV torsion, playing a role in maintaining LVEFs in patients with HF-recovered.…”