title: Strain and Strain Rate Measured on Echocardiogram 1-3 Weeks after Starting Treatment Is Worse in Acute Dilated Cardiomyopathy Pediatric Patients with Poor Outcomes at One Year.
abstract: BACKGROUND
  Predicting later outcome around time of diagnosis of acute dilated cardiomyopathy (DCM) is difficult. We hypothesized that strain and strain rate on initial and follow-up echoes were worse in patients with acute DCM from all causes with poor one-year outcomes.
  
  
  METHODS
  This was a retrospective study including all patients with DCM aged 0-18 years with left ventricle dilation, low ejection fraction, or low fractional shortening on initial echo. Longitudinal and circumferential strain and systolic and diastolic strain rate were measured on echo at presentation, 1-3 weeks after presentation, and at 1 year. Patients were separated into "Stable" (survivors) and "Progressive" (referred for transplant or died) outcome groups, and results were analyzed to determine whether strain or strain rate at each echo was worse in the "Stable" group compared with the "Progressive" group.
  
  
  RESULTS
  The patient population included patients with DCM from idiopathic causes, myocarditis, iron deficiency anemia, lupus, chemotherapy, and LV noncompaction. Longitudinal and circumferential strain and systolic strain rate were significantly better in the "Stable" (n = 7) compared with the "Progressive" (n = 8) outcome group on 1- to 3-week echo. Longitudinal strain more negative than -10% had 87% specificity and 100% sensitivity for predicting "stable" outcome (AUC 0.98), while circumferential strain more negative than -8% had 60% specificity and 100% sensitivity (AUC 0.83).
  
  
  CONCLUSIONS
  Longitudinal and circumferential strain and systolic strain rate measured 1-3 weeks after starting therapy are worse in acute dilated cardiomyopathy patients with poor one-year outcomes. Further studies with less heterogeneity and more study subjects are needed.
authors: University of Texas Southwestern, Dallas, Texas.
authors: Melissa K
authors: MK
authors: Webb
authors: University of Colorado School of Medicine and Children's Hospital Colorado, Denver, Colorado.
authors: Scott R
authors: SR
authors: Auerbach
authors: University of Colorado School of Medicine and Children's Hospital Colorado, Denver, Colorado.
authors: Adel K
authors: AK
authors: Younoszai
authors: University of Colorado School of Medicine and Children's Hospital Colorado, Denver, Colorado.
authors: Sonali S
authors: SS
authors: Patel
authors: University of Colorado School of Medicine and Children's Hospital Colorado, Denver, Colorado.
authors: Bruce F
authors: BF
authors: Landeck
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000469:parasitology / Q000503:physiopathology
chemical_list: D002316:Cardiotonic Agents
keywords: dilated cardiomyopathy; strain; strain rate imaging