Abstract 9920: Evaluation of Global Circumferential Strain as Prognostic Marker After Administration of β-blockers for Dilated Cardiomyopathy

Abstract

Background: The prognosis of dilated cardiomyopathy (DCM) has improved by the use of β-blockers, and the appearance of left ventricular (LV) reverse remodeling is generally thought to result in a favorable prognosis. Although there are many prognostic predictors, they are not sensitive in individual patients. It is recently reported that global circumferential strain (GCS) is a powerful predictor of cardiac events and appears to be a better parameter than LV global function in heart failure patients. Accordingly, the objective of our study was to test the hypothesis that GCS predicted LV reverse remodeling after administration of β-blockers in patients with DCM. Methods: Fifty patients with DCM with EF of 28±8% (all<45%) were prospectively recruited. Either carvedilol or bisoprolol was titrated to a targeting dose depending on the tolerability of each patient. Echocardiography was performed at enrollment and 8±5 months after the maintenance dose of β-blockers. LV reverse remodeling was defined as the presence of an absolute increase in EF of at least 10%. GCS was determined as the peak global speckle-tracking circumferential strain from mid-LV short-axis view. Event-free survival was tracked over 30-month. Results: Among all indices, GCS<-4.01% best predicted responders, with 100% sensitivity, 62% specificity, and an area under the curve of 0.796 (p= 0.0004). On multivariate Cox proportional-hazards analysis, GCS was the independent and the most powerful predictor of LV reverse remodeling (hazard ratio, 1.228; p=0.02). Furthermore, patients with GCS<-4.01% experienced fewer cardiovascular events than those with GCS≥-4.01% (log-rank p=0.023). Conclusions: GCS predicted LV reverse remodeling after administration with β-blockers, and was also associated with long-term outcome in patients with DCM. GCS may reflect intrinsic LV myocardial function , and have clinical implications for better management of such patients.