title: Evaluation of global circumferential strain as prognostic marker after administration of β-blockers for dilated cardiomyopathy.
abstract: The use of β-blockers has improved the prognosis of dilated cardiomyopathy (DCM) and the appearance of left ventricular (LV) reverse remodeling is generally thought to result in a more favorable prognosis. While there are many prognostic predictors, not all of them are applicable to individual patients. Global circumferential strain (GCS) was identified as a powerful prognostic marker, which appears to be a better parameter than LV global function for patients with depressed left ventricular (LV) ejection fraction. Seventy consecutive patients with newly-diagnosed DCM with LVEF of 28 ± 8 % (all <45 %) were retrospectively recruited. Either carvedilol or bisoprolol was titrated to a dose that was tolerable for each of the patients. GCS was determined as the peak global speckle-tracking circumferential strain from the mid-LV short-axis view. LV reverse remodeling was defined as an absolute increase in LVEF of at least 10 % during 8.1 ± 5.2-month follow-up after initiation of the maintenance dose of β-blockers. GCS ≥ 5.4 % was identified as the best predictor of LV reverse remodeling with 91 % sensitivity and 82 % specificity, and an area under the curve of 0.896 (p < 0.0001). An important finding of multivariate logistic regression analysis was that GCS was the best independent predictor of LV reverse remodeling (OR 7.692; 95 % CI 2.292-25.82; p = 0.001). It should be noted that only 1.3 ± 0.4 min per patient was needed to analyze GCS. In conclusions, GCS could result in further improvements in predicting LV reverse remodeling after β-blocker administration, and have clinical implications for better management in daily clinical practice.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan, tanakah@med.kobe-u.ac.jp.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Kensuke
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Takuma
authors.initials: T
authors.lastname: Sawa
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Miyoshi
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Motoji
authors.forename: Junichi
authors.initials: J
authors.lastname: Imanishi
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Mochizuki
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Tatsumi
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D017298:Bisoprolol / Q000008:administration & dosage; D002227:Carbazoles / Q000008:administration & dosage; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D000077261:Carvedilol; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction / Q000187:drug effects*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011412:Propanolamines / Q000008:administration & dosage; D012372:ROC Curve; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000187:drug effects*; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000187:drug effects*; D020257:Ventricular Remodeling / Q000187:drug effects*
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D017298:Bisoprolol