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Left ventricular function in dilated cardiomyopathy - acoustic quantification assessment
E. Michalak, J. Grzybowski, Z.T. Bilinska, M. Skwarek, W. Rużyłło, W. Rydlewska-Sadowska,
National Institute of Cardiology, Warsaw, Poland.
Left ventricular (LV) function was assessed in 41 pts with dilated cardiomyopathy (DCM) aged 37,0+/-10,7yrs and 33 controls aged 38,6+/-9,0yrs with good quality echocardiograms. Automatic boundary detection (ABD) with modified Simpson's method was used for LV volume estimation from apical 2-chamber view. We evaluated: LV enddiastolic volume (LVEDV), ejection fraction (EF%), % volume change during rapid filling (RF%) and filling due to atrial contraction (AF%) in relation to filling volume, maximal LV volume change during rapid filling (dV/dtRF) and filling due to atrial contraction (dv/dtAF), normalized peak filling rate (PFR), time to peak filling rate (tPFR) and normalized peak ejection rate (PER). Mean pulmonary wedge pressure (mPWP) and ejection fraction were determined invasively after echocardiographic study in DCM. Results:





 

DCM

Control

P


LVEDV (ml)

183,0 +/-83,3

71,7 +/-20,7

<0,0001


LVEF (%)

25,2 +/-10,0

58,2 +/- 7,1

<0,0001


%RF (%)

61,7 +/- 15,6

70,7 +/- 9,2

<0,05


%AF (%)

40,0 +/-11,2

29,6 +/-12,9

<0,04


dV/dtRF (ml/s)

355,5 +/-150,2

276,4 +/- 95,6

<0,02


dV/dtAF (ml/s)

243,4 +/-110,2

168,4 +/-67,8

<0,004


PFR (EDV/s)

2,4 +/-0,71

4,2 +/- 0,83

<0,001


tPFR (ms)

77,2 +/- 35,8

114,0 +/-63,4

<0,01


PER (EDV/s)

1,8 +/-0,79

3,5 +/- 0,47

<0,0001



We found negative correlation between mPWP and PFR (r=-0,49), PER(r=-0,54)and tPFR (r=-0,28), The DCM group we divided into 2 supgroups:A- with mPWP >= 20mmHg, B- with mPWP < 20mmHg. We noticed significantly reduced PFR (2,0+/-0,65 vs 2,6+/-0,77 EDV/s, p<0,03) and PER (1,4+/-0,5 vs 2,2+/-0,93 EDV/s, p<0,02) in group A compared to group B. The correlation between LVEF obtained invasively and from ABD was strong (r=0,84).
Conclusions: Acoustic quantification is an effective noninvasive method to assess LV function in pts with DCM in which reduced peak filling rate, time to peak filling rate, peak emptying rate are observed. Markedly reduced peak and time to peak LV rapid filling, peak ejection rate suggest significantly increased filling pressure with increased chamber stiffness enlarged LV and can be a marker of poor prognosis.




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