Predicting Myocardial Recovery in Children with Dilated Cardiomyopathy

Abstract

Purpose Dilated cardiomyopathy (DCM) is a common indication for heart transplantation (Tx) in children but not all progress to Tx. Standard 2D echocardiography (2DE) and Doppler techniques do not predict which patients will recover function. Myocardial function can be reliably determined using Velocity Vector Imaging (VVI), an angle independent method of evaluating myocardial mechanics using conventional 2DE images. We believe VVI provides a valid and reproducible measure of myocardial function in DCM patients with correlation to clinical outcomes. Methods and Materials Medical records and 2DEs were retrospectively reviewed on patients with DCM. VVI analysis was performed offline using Siemens Syngo software. Using VVI on a 4 chamber image, longitudinal velocity (LVel), strain (S), strain rate (SR) were obtained. Ventricular functional parameters were compared to normal. Results 22 patients were treated for DCM − 8 patients recovered function, 4 patients underwent Tx, 3 patients were listed for Tx, 7 patients died without recovering or while awaiting Tx. Mortality was associated with mechanical, ventilatory support, and renal failure. The overall mortality rate was 36% (8/28). LVel, S, and SR were decreased compared to normal in all groups. LVel, S, and SR were statistically different in those who progressed to Tx and listed for Tx compared to those who did recover. S and SR did not return to normal even in the group who clinically recovered. Ejection fraction and 2DE dimensions correlated with VVI parameters. Conclusions VVI derived myocardial functional parameters do not return to normal despite clinical recovery and return to normal of conventional 2DE parameters. VVI is an effective tool to predict degree of myocardial recovery and serves as an adjunct to conventional 2DE measures of systolic and diastolic function.