Prediction of Short-Term Outcomes in Patients With Idiopathic Dilated Cardiomyopathy Referred for Transplantation Using Standard Echocardiography and Strain Imaging

Abstract

Objective We sought to evaluate the short-term prognostic value of echocardiography including two-dimensional (2D) strain imaging in patients with end-stage idiopathic dilated cardiomyopathy (IDCM). Methods To evaluate the short-term (6-month) prognostic value of different parameters used for the assessment of IDCM patients referred for heart transplantation, we performed at the baseline transthoracic echocardiography including 2D strain imaging, N-terminal pro-BNP measurements, and exercise testing for all patients included in the study. After 6 months, all parameters, including endsystolic strain (ESS), peak systolic strain rate (SSR max), early and late diastolic strain rates, their ratio (diastolic strain rate E [DSR E], dialostolic strain rate A [DSR A], diastolic strain rate E and A wave ratio [DSR E/A]), and systolic intraventricular dyssynchrony indexes (IVDSI) were tested for their prognostic value to predict a patient's outcome. Results At the baseline stable patients had significantly lower transmitral E and A wave ratio (E/A), DSR E/A, higher DSR A values, longer transmitral E wave deceleration time (DcT), higher longitudinal ESS and SSR max values, lower systolic circumferential and longitudinal IVDSI. Conclusion The highest sensitivity for rapid heart failure progression was shown by DcT <100 ms, E/A > 1.5, DSR A < 0.3/s, circumferential IVDSI > 0.16, and longitudinal IVDSI > 0.22 (91%, 78%, 94%, 83%, and 75%, respectively).