Usefulness of ventricular longitudinal contractility assessed by Doppler tissue imaging in the prediction of reverse remodeling in patients with severe left ventricular systolic dysfunction.
OBJECTIVE
We sought to test if assessment of ventricular longitudinal contractility (LC) by Doppler tissue imaging (DTI) can predict reverse remodeling (RR) of left ventricular (LV) dysfunction resulting from medical treatment.


METHODS
DTI was performed in 35 patients with nonischemic LV dysfunction (ejection fraction 26 +/- 7%) and LC was assessed at the 4 different basal segments of the LV walls (septal, lateral, inferior, and anterior) using myocardial velocity curves and strain measurements; the peak systolic or delayed longitudinal contraction velocity of LV walls only with concomitant negative strain were measured and added to represent LC of each patient (LC by DTI). Successful RR was defined as a reduction of LV end-systolic volume of greater than 15%.


RESULTS
RR was observed in 13 patients (37%, group A). Initial LV ejection fraction was similar in patients who did and did not achieve RR (group B). Compared with group B, group A showed shorter QRS interval (110 +/- 36 vs 136 +/- 28 milliseconds, P = .022), shorter symptom duration (2.3 +/- 3.5 vs 4.2 +/- 3.4 years, P = .047), lower prevalence of left bundle branch block (23% vs 59%, P = .039), and higher value of LC by DTI (9.6 +/- 3.5 vs 6.3 +/- 3.6 cm/s, P = .011). Multivariate analysis revealed that symptom duration less than 2 years (odds ratio = 8.0, 95% confidence interval = 1.3-47.2, P = .022) and LC by DTI (odds ratio = 1.3, 95% confidence interval = 1.0-1.7, P = .019) were independent predictors of RR.


CONCLUSIONS
DTI provides a new index of LC, which is useful for predicting RR in patients with severe LV dysfunction.
Kang
Soo-Jin
SJ
Division of Cardiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea.
Song
Jae-Kwan
JK
Song
Jong-Min
JM
Kang
Duk-Hyun
DH
Lee
Eun Young
EY
Kim
Jun
J
Nam
Gi-Byoung
GB
Choi
Kee-Joon
KJ
Kim
Jae-Joong
JJ
Kim
You-Ho
YH
D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000000981:diagnostic imaging*; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology; D020257:Ventricular Remodeling