J Cardiovasc Imaging.  2020 Apr;28(2):137-149. 10.4250/jcvi.2019.0111.

Left Ventricular Global Longitudinal Strain as a Predictor for Left Ventricular Reverse Remodeling in Dilated Cardiomyopathy

• Jung IH
• Park JH
• Lee JA
• Kim GS
• Lee HY
• Byun YS
• Kim BO

• KMID: 2509455
• DOI: http://doi.org/10.4250/jcvi.2019.0111

Abstract

BACKGROUND
A considerable number of patients with dilated cardiomyopathy (DCM) experience left ventricular reverse remodeling (LVRR). LV global longitudinal strain (LV GLS) offers sensitive and reproducible measurement of myocardial dysfunction. The authors sought to evaluate whether LV GLS at the time of diagnosis may predict LVRR in DCM patients with sinus rhythm and investigate its prognostic role in long-term follow-up in this population.
METHODS
We enrolled 160 DCM patients with sinus rhythm who had been initially diagnosed, evaluated, and followed at our institute. We analyzed their medical records and echocardiographic data.
RESULTS
During the mean follow-up duration of 37.3 ± 21.7 months, LVRR occurred in 28% of patients (n = 45). The initial LV ejection fraction (LVEF) of patients who recovered LV function was 26.1 ± 7.9%, which was not significantly different from the value of 27.1 ± 7.4% (p = 0.49) in those who did not recover. There was a moderate and highly significant correlation between baseline LV GLS (−%) and follow-up LVEF (r = 0.717; p < 0.001). Using multivariate Cox analysis, LV GLS (hazard ratio: 1.474, 95% confidence interval: 1.170-1.856; p = 0.001) was an independent predictor of LVRR.
CONCLUSIONS
We demonstrated that LV GLS was an independent predictor for LVRR and the optimal cut-off point of LV GLS for LVRR was −10% in DCM patients with sinus rhythm. There was a significant correlation between baseline LV GLS and follow-up LVEF.

Keyword

Dilated cardiomyopathy; Echocardiography; Strain; Left ventricle

Figure

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  Figure 1 Study flow chart. AF: atrial fibrillation, CKD: chronic kidney disease, CRT: cardiac resynchronization therapy, DCM: dilated cardiomyopathy, ICD: implantable cardioverter defibrillator, i-PHT: idiopathic pulmonary hypertension, LVRR: left ventricular reverse remodeling, PPM: permanent pacemaker, PTE: pulmonary thromboembolism, TTE: transthoracic echocardiography, VHD: valvular heart disease.

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  Figure 2 Changes in LV GLS of the patients without LVRR (A) and with LVRR (B). The mean difference of LV GLS between baseline and follow-up in both groups were significant; however, LV GLS was more prominent in patients with LVRR. The mean of differences of LV GLS (−%) of patients without LVRR vs. with LVRR were 0.5 ± 1.3% vs. 5.1 ± 2.9% (p < 0.001). LV GLS: left ventricular global longitudinal strain, LVRR: left ventricular reverse remodeling.

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  Figure 3 There was a moderate but highly significant correlation (r = 0.717, p < 0.001) between baseline LV GLS and follow-up LVEF. LV GLS: left ventricular global longitudinal strain, LVEF: left ventricular ejection fraction.

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  Figure 4 Kaplan-Meier curves for event-free survival according to the patients with and without LVRR (A), and two groups divided by LV GLS of −10% (B). LV GLS: left ventricular global longitudinal strain, LVRR: left ventricular reverse remodeling.

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