Abstract
BackgroundRisk stratification in patients with non-ischemic dilated cardiomyopathy (NI-DCM) is essential to treatment planning. Global longitudinal strain (GLS) predicts poor prognosis in various cardiac diseases, but it has not been evaluated in a cohort of exclusively NI-DCM. Although deformation parameters have been shown to reflect diastolic function, their association with other hemodynamic parameters needs further elucidation. We aimed to evaluate the association between GLS and E/GLS and invasive hemodynamic parameters and assess the prognostic value of GLS and E/GLS in a prospective well-defined pure NI-DCM cohort.Methods and resultsForty-one patients with NI-DCM were enrolled in the study. They underwent a standard diagnostic workup, including transthoracic echocardiography and right heart catheterization. During a five-year follow-up, 20 (49%) patients reached the composite outcome measure: LV assist device implantation, heart transplantation, or cardiovascular death.Pulmonary capillary wedge pressure (PCWP), mean pulmonary artery pressure, pulmonary vascular resistance (PVR) correlated with GLS and E/GLS (p < 0.05). ROC analysis revealed that GLS and E/GLS could identify elevated PCWP (≥ 15 mmHg) and PVR (> 3 Wood units). Survival analysis showed GLS and E/GLS to be associated with short- and long-term adverse cardiac events (p < 0.05). GLS values above thresholds of –5.34% and -5.96% indicated 18- and 12-fold higher risk of poor clinical outcomes at one and five years, respectively. Multivariate Cox regression analysis revealed that GLS is an independent long-term outcome predictor.ConclusionGLS and E/GLS correlate with invasive hemodynamics parameters and identify patients with elevated PCWP and high PVR. GLS and E/GLS predict short- and long-term adverse cardiac events in patients with NI-DCM. Worsening GLS is associated with incremental risk of long-term adverse cardiac events and might be used to identify high-risk patients.
Highlights
Non-ischemic dilated cardiomyopathy (NI-DCM)— one of the main causes of heart failure—eventually leads to a high need for device therapy and heart transplantation
global longitudinal strain (GLS) and E/GLS correlate with invasive hemodynamics parameters and identify patients with elevated Pulmonary capillary wedge pressure (PCWP) and high pulmonary vascular resistance (PVR)
Worsening GLS is associated with incremental risk of long-term adverse cardiac events and might be used to identify high-risk patients
Summary
Non-ischemic dilated cardiomyopathy (NI-DCM)— one of the main causes of heart failure—eventually leads to a high need for device therapy and heart transplantation. GLS predicts poor prognosis in various cardiac diseases, including ischemic heart disease [2, 3] and heart failure with reduced ejection fraction (HFrEF) [4,5,6]. Studies investigating mixed HFrEF populations have included patients with ischemic heart disease (usually half of the cohort), who have a worse prognosis than patients with non-ischemic heart failure [7, 8]. Global longitudinal strain (GLS) predicts poor prognosis in various cardiac diseases, but it has not been evaluated in a cohort of exclusively NI-DCM. We aimed to evaluate the association between GLS and E/GLS and invasive hemodynamic parameters and assess the prognostic value of GLS and E/GLS in a prospective well-defined pure NI-DCM cohort
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