title: Subclinical myocardial dysfunction in patients with reverse-remodeled dilated cardiomyopathy.
abstract: BACKGROUND
  The aim of this study was to test the hypothesis that patients with reverse-remodeled dilated cardiomyopathy (DCM), whose ejection fractions (EFs) were normalized after optimal pharmacologic therapy, had subclinical myocardial dysfunction.
  
  
  METHODS
  Thirty-two patients with reverse-remodeled DCM, defined as having an initial EF ≤ 35%, which then recovered to ≥50% after optimal pharmacologic therapy, and 11 normal controls with preserved EFs were retrospectively studied. Averaged peak systolic and early diastolic radial, circumferential, and longitudinal speckle-tracking strain rates were assessed from an 18-segment left ventricular model. Similarly, averaged peak systolic radial, circumferential, and longitudinal speckle-tracking strain was obtained.
  
  
  RESULTS
  Peak systolic and early diastolic longitudinal strain rates, peak systolic and early diastolic circumferential strain rates, and peak circumferential and longitudinal strain in patients with reverse-remodeled DCM were significantly lower than those in normal controls, but peak systolic and early diastolic radial strain rates and peak radial strain in patients with reverse-remodeled DCM were similar to those in normal controls. Isometric handgrip stress testing showed a significant decrease in EF from 56 ± 5% to 51 ± 5% (P < .001). Of note, the increase of afterload resulting from isometric handgrip stress testing was associated with a decrease in peak systolic circumferential and longitudinal strain rates and peak circumferential strain in patients with reverse-remodeled DCM.
  
  
  CONCLUSIONS
  The circumferential and longitudinal myocardial function of patients with reverse-remodeled DCM is lower compared with that of normal controls with preserved EFs. Furthermore, the increase in afterload was associated with the decrease in circumferential and longitudinal myocardial systolic function. These findings suggest that in treated patients with DCM with reverse remodeling, left ventricular mechanics may not be normal, even when EFs are normal.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Okada
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Kensuke
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Keiko
authors.initials: K
authors.lastname: Ryo
authors.forename: Hiroya
authors.initials: H
authors.lastname: Kawai
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000000981:diagnostic imaging*; D004452:Echocardiography / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology*