title: Segmental wall motion abnormalities in idiopathic dilated cardiomyopathy and their effect on prognosis.
abstract: There is considerable variability in segmental wall motion abnormalities and in the prognosis of idiopathic dilated cardiomyopathy (IDC). Radionuclide ventriculography with Fourier analysis was performed in 107 patients with angiographically proved IDC. Amplitude analysis located the wall motion abnormalities. Using phase analysis in the left and right ventricles, the interventricular delay between the mean phase of the right and left ventricles was used to assess interventricular dyssynchrony and SDs of the mean phase in each ventricle was used to assess intraventricular dyssynchrony. Hypokinesis was global in 56 patients (52%) and localized in the anteroseptal wall in 34 (32%), the inferior wall in 12 (11%), the anteroseptal and inferior walls in 2 (2%), and the lateral wall in 3 (3%). Patients with localized wall motion abnormalities had larger left ventricular (LV) end-diastolic diameters (70 +/- 9 vs 66 +/- 8 mm, p = 0.009) and lower LV ejection fractions (25 +/- 9% vs 31 +/- 12%, p = 0.005). Intraventricular dyssynchrony was lower in patients with global hypokinesis (SD of LV mean phase 67 +/- 35 vs 48 +/- 22 ms, p = 0.002). With a follow-up of 27 +/- 23 months, increased SD of the LV phase (p = 0.005), decreased right ventricular ejection fraction (p = 0.006), decreased LV ejection fraction (p = 0.04), and localized wall motion abnormality (p = 0.009) were independent predictors of cardiac death or worsening heart failure leading to heart transplantation. Thus, segmental wall motion abnormalities are frequent in IDC and are associated with severe systolic dysfunction and a worse prognosis.
authors.affiliation: Services de Service de Cardiologie B, Centre Hospitalier Universitaire Trousseau, Tours, France. lfau@med.univ-tours.fr
authors.forename: Laurent
authors.initials: L
authors.lastname: Fauchier
authors.forename: Veronique
authors.initials: V
authors.lastname: Eder
authors.forename: Danielle
authors.initials: D
authors.lastname: Casset-Senon
authors.forename: Olivier
authors.initials: O
authors.lastname: Marie
authors.forename: Dominique
authors.initials: D
authors.lastname: Babuty
authors.forename: Pierre
authors.initials: P
authors.lastname: Cosnay
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Fauchier
mesh_terms: D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D005583:Fourier Analysis; D015637:Gated Blood-Pool Imaging; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D018476:Hypokinesia / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology; D013667:Technetium; D018754:Ventricular Dysfunction / Q000000981:diagnostic imaging / Q000503:physiopathology
chemical_list: D013667:Technetium