Evaluation of global circumferential strain as prognostic marker after administration of β-blockers for dilated cardiomyopathy

Int J Cardiovasc Imaging. 2014 Oct;30(7):1279-87. doi: 10.1007/s10554-014-0463-3. Epub 2014 Jun 5.

Abstract

The use of β-blockers has improved the prognosis of dilated cardiomyopathy (DCM) and the appearance of left ventricular (LV) reverse remodeling is generally thought to result in a more favorable prognosis. While there are many prognostic predictors, not all of them are applicable to individual patients. Global circumferential strain (GCS) was identified as a powerful prognostic marker, which appears to be a better parameter than LV global function for patients with depressed left ventricular (LV) ejection fraction. Seventy consecutive patients with newly-diagnosed DCM with LVEF of 28 ± 8 % (all <45 %) were retrospectively recruited. Either carvedilol or bisoprolol was titrated to a dose that was tolerable for each of the patients. GCS was determined as the peak global speckle-tracking circumferential strain from the mid-LV short-axis view. LV reverse remodeling was defined as an absolute increase in LVEF of at least 10 % during 8.1 ± 5.2-month follow-up after initiation of the maintenance dose of β-blockers. GCS ≥ 5.4 % was identified as the best predictor of LV reverse remodeling with 91 % sensitivity and 82 % specificity, and an area under the curve of 0.896 (p < 0.0001). An important finding of multivariate logistic regression analysis was that GCS was the best independent predictor of LV reverse remodeling (OR 7.692; 95 % CI 2.292-25.82; p = 0.001). It should be noted that only 1.3 ± 0.4 min per patient was needed to analyze GCS. In conclusions, GCS could result in further improvements in predicting LV reverse remodeling after β-blocker administration, and have clinical implications for better management in daily clinical practice.

MeSH terms

  • Adrenergic beta-Antagonists / administration & dosage*
  • Adult
  • Aged
  • Area Under Curve
  • Bisoprolol / administration & dosage
  • Carbazoles / administration & dosage
  • Cardiomyopathy, Dilated / diagnosis
  • Cardiomyopathy, Dilated / drug therapy*
  • Cardiomyopathy, Dilated / physiopathology
  • Carvedilol
  • Chi-Square Distribution
  • Disease-Free Survival
  • Echocardiography, Doppler, Color
  • Echocardiography, Doppler, Pulsed
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Contraction / drug effects*
  • Odds Ratio
  • Predictive Value of Tests
  • Propanolamines / administration & dosage
  • ROC Curve
  • Recovery of Function
  • Retrospective Studies
  • Risk Factors
  • Stroke Volume / drug effects*
  • Time Factors
  • Treatment Outcome
  • Ventricular Dysfunction, Left / diagnosis
  • Ventricular Dysfunction, Left / drug therapy*
  • Ventricular Dysfunction, Left / physiopathology
  • Ventricular Function, Left / drug effects*
  • Ventricular Remodeling / drug effects*

Substances

  • Adrenergic beta-Antagonists
  • Carbazoles
  • Propanolamines
  • Carvedilol
  • Bisoprolol