Usefulness of ventricular longitudinal contractility assessed by Doppler tissue imaging in the prediction of reverse remodeling in patients with severe left ventricular systolic dysfunction.

摘要

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.