Evaluation of Left Ventricular Contraction Abnormalities in Patients with Dilated Cardiomyopathy with the Use of Pulsed Tissue Doppler Imaging,☆☆

https://doi.org/10.1016/S0894-7317(99)70143-4Get rights and content

Abstract

The left ventricular (LV) systolic wave, as recorded by pulsed tissue Doppler imaging, usually consists of 2 components (Sw1 and Sw2). However, the clinical significance of these waves has not been studied in patients with dilated cardiomyopathy (DCM) and sinus rhythm. We studied 25 patients with DCM (DCM group) and 22 age-matched normal subjects (control group). The LV posterior wall motion velocities along the short and long axes were recorded by pulsed tissue Doppler imaging, and the peak velocities of the Sw1 and Sw2 and the times from the electrocardiographic Q wave to the peak Sw1 and Sw2 (Q-Sw1 and Q-Sw2, respectively) were determined. In all patients cardiac catheterization was performed immediately after the noninvasive examination, and the LV end-diastolic pressure and peak dP/dt were determined. The LV end-diastolic pressure and peak dP/dt were significantly greater and lower, respectively, in the DCM group. The peak Sw1 along the long axis was significantly greater than Sw1 and Sw2 along the short axis and Sw2 along the long axis in the control group. The peak Sw1 and Sw2 along the long and short axes were all significantly lower in the DCM group than in the control group. The Q-Sw1 along the long axis was significantly shorter than that along the short axis, whereas no significant difference was seen in the Q-Sw2 in either axis in any patient. The Q-Sw1 and Q-Sw2 along both axes were significantly longer in the DCM group than in the control group. All systolic pulsed tissue Doppler imaging variables, particularly the peak Sw1 along the long axis, correlated well with the peak dP/dt in all patients. LV contractility along both the short and long axes is commonly impaired in patients with DCM. In particular, peak Sw1 along the long axis is a useful parameter for evaluating LV myocardial contractility during isovolumic contraction. (J Am Soc Echocardiogr 1999;13:913-20.)

Section snippets

Patient Population

We studied 25 consecutive patients with DCM who were in sinus rhythm and who had been referred to our institution for diagnostic tests between May 1995 and May 1998. The 25 patients with DCM showed no signs of significant stenosis or obstruction of the coronary arteries; however, LV dilation and diffuse asynergy of the LV wall were observed.

Exclusion criteria included (1) hemodynamically significant valvular heart disease, (2) right or left bundle branch block, (3) β-blocker or digoxin therapy,

Clinical and M-Mode Echocardiographic Variables

No significant differences were seen in age and heart rate between the DCM and control groups (Table 1).

. Clinical and M-mode echocardiographic variables

GroupNo.Age (y)HR (bpm)LVDd (cm)LVDs (cm)%FS (%)LAD (cm)
Control2257 ± 1078 ± 114.5 ± 0.42.6 ± 0.441 ± 63.3 ± 0.4
DCM2557 ± 1184 ± 126.3 ± 0.8*5.1 ± 1.0*18 ± 6*4.1 ± 0.4*
*< .0001 vs control group.

DCM , Dilated cardiomyopathy; HR , heart rate; LVDd , end-diastolic left ventricular dimension; LVDs , end-systolic left ventricular dimension; %FS,

DISCUSSION

Usually, LV ejection fraction,18, 19, 20, 21 maximum elastance (Emax) as a parameter relating instantaneous intraventricular pressure to volume,22 end-systolic wall stress,17 and the mean rate of circumferential fiber shortening23 are used to evaluate the LV systolic function. However, these parameters are influenced by loading conditions or require the use of an invasive method. The LV myocardium consists of circumferential fibers of the mid-wall and longitudinal fibers of the subendocardial

References (38)

Cited by (81)

  • Dilated Cardiomyopathy, Myocarditis, and Heart Transplantation

    2021, Echocardiography in Pediatric and Congenital Heart Disease: From Fetus to Adult: Third Edition
  • Dilated Cardiomyopathy, Myocarditis, and Heart Transplantation

    2016, Echocardiography in Pediatric and Congenital Heart Disease: From Fetus to Adult: Second Edition
  • Assessment of ventricular-vascular function by echocardiography

    2015, Congenital Heart Disease: Morphological and Functional Assessment
View all citing articles on Scopus

Reprint requests: Takashi Oki, MD, Second Department of Internal Medicine, School of Medicine, The University of Tokushima, 2-50 Kuramoto-cho, Tokushima 770-8503, Japan.

☆☆

0894-7317/99 $8. 00 + 0  27/4/101364

View full text