Assessment of left ventricular dysfunction in non-ischemic dilated cardiomyopathy by 2D strain echocardiography: Diagnostic and prognostic value

Aims: The principal application of left ventricular (LV) regional wall motion analysis is for diagnosis and follow-up of ischemic heart disease. However, regional LV wall motion alterations also occur in DCM; we assessed their prevalence, degree and potential clinical impact.

Methods: 2D strain, a novel non-Doppler-based method for quantitative assessment of myocardial function was used for wall motion analysis in 40 DCM patients with sinus rhythm. Radial, circumferential and longitudinal strain and strain rate were calculated in parasternal short axes and apical views, respectively. Regional and global strain and strain rate values were tested for relationships to hemodynamics, results of exercise testing, and pro-BNP serum levels.

Results: LV diameters, EF and global end-systolic strain did not correlate with LV enddiastolic pressure (LVEDP), pro-BNP or peak VO2. Regional wall motion disturbances were shown in all patients. Systolic dyssynchrony index at LV basal wall segments correlated with LVEDP, pro-BNP and peak VO2 (p<0.01). Also, systolic and diastolic strain dyssynergy indexes of different wall segments correlated with LVEDP, pro-BNP and peak VO2 (p<0.01). Among patients with similar LVEF and interventricular asynchrony, those who required inotropic support showed higher dyssynchrony and dyssynergy and lower strain rate values than those who were clinically stable (p<0.01).

Conclusions: Dyssynchrony and dyssynergy of LV contraction and relaxation were revealed by 2D strain in all DCM patients and were more closely related to hemodynamic alterations, exercise intolerance and patients' outcome than LVEF. In DCM patients, the 2D strain method provides more information on LV myocardial dysfunction than conventional echocardiography.