Clin Res Cardiol 101, Suppl 1, April 2012

P701 - Early diastolic strain rate predicts response to heart failure therapy in patients with dilated cardiomyopathy
 
B. Goebel1, K. Haugaa2, S. Otto1, C. Jung1, A. Lauten1, G. Mall3, H.-R. Figulla1, T. Edvardsen2, T. Poerner1
 
1Klinik für Innere Medizin I, Universitätsklinikum Jena, Jena; 2Department of Cardiology, Rikshospitalet University Hospital and University of Oslo, Oslo, Norwegen; 3Institut für Pathologie, Klinikum Darmstadt, Darmstadt;
 
Objective: The aim of this prospective study was to assess the value of speckle tracking echocardiographic (STE) parameters to predict response to heart failure therapie in patients with dilated cardiomyopathy (DCM).
Methods: Eighty-seven patients (mean age 51 ± 13 years) with DCM, defined as ejection fraction (EF) < 45 %, left ventricular end-diastolic diameter of > 112% predicted value and normal coronary angiogram were included. EF, left ventricular end-diastolic diameter (LVEDDI) and volume (LVEDVI) indexed to body surface area were measured. Greyscale cine-loops were obtained from three apical views (4-chamber, 2-chamber and apical long axis) of the left ventricle (LV). Based on STE following parameters were extracted: overall strain (Soverall), systolic (SRS) and diastolic strain rate (SRE). The parameters were expressed as mean values between all LV segments. After receiving heart failure therapy (mean 25 months, range 1.5 - 42) 50 patients reached the combined endpoint defined as: death, heart transplantation, rehospitalisation due to acute heart failure, and decrease or absence of improvement of EF (>10%) .
Results: The results of univariate and multivariate logistic regression analysis for prediction of combined endpoint are displayed in Table 3. In univariate regression analyse EF, LV diameters and volumes indexed to BSA were predictive for the combined endpoint. But in multivariate regression analyses only SRE, SRS and LVEDV were predictive irrespective which further echocardiographic parameter was included in the model as covariate.
In patients with small QRS complex (<120ms) only SRE was predictive in the multivariate analysis

 

 

OR (95%CI)

p

OR (95%CI)

p

  Univariate Multivariate
  All patients
EF study (per 5% decrease) 0.58 (0.43-0.77) <0.001 - -
LVEDDI(per 1mm/m² increase) 1.19 (1.06-1.32) 0.002 - -
LVEDVI (per 10ml/m² increase) 1.53 (1.23-1.89) <0.001 1.73 (1.12-2.68) 0.014
Soverall (per 1% increase) 0.79 (0.63-0.85) <0.001 - -
SRS (per 0.1s-1 decrease)) 0.70 (0.56-0.88) 0.002 1.99 (1.12-3.53) 0.019
SRE (per 0.1s-1 increase) 0.50 (0.38-0.67) <0.001 0.44 (0.23-0.68) <0.001
  Patients with cQRS duration <120ms
EF study (per 5% decrease) 0.66 (0.46-0.95) 0.024 - -
LVDVI (per 10ml/m² increase) 1.82 (1.24-2.69) 0.002 - -
Soverall (per 1% increase) 0.72 (0.56-0.92) 0.010 - -
SRE (per 0.1s-1 increase) 0.43 (0.26-0.71) 0.001 0.21 (0.06-0.73) 0.013

The area under the ROC-curves for different parameters were calculated with the following results: EF (Area=0.79; p<0.001), LVEDDI (Area=0.67; p=0.009), LVEDVI (Area=0.80; p<0.001), S overall (Area=0.75; p<0.001), SRS (Area=0.70; p=0.002) and SRE (Area=0.90; p<0.001). Optimal cut off value for SRE  was <0.67s-1 and discriminated between those with and without response to medical treatment with a sensitivity of 90% and specificity of 74%.
Conclusions: In this small, prospective study, SRE, which measures regional diastolic relaxation, was the best predictor of response to medical heart failure therapy in patients with DCM, being superior to LV dimensions.
 

Clin Res Cardiol 101, Suppl 1, April 2012
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-012-1100-6

http://www.abstractserver.de/dgk2012/ft/abstracts/P701.htm