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Left Ventricular Remodeling In Dilated Cardiomyopathy: Relation To Clinical Status And Cardiac Function

Contact Person: Andrei V Grachev (nimed@silk.org)


Table 1 summarizes the clinical, echocardiographic and Doppler data in patients with DC and control subjects. There was no significant differences between the two groups in age, systolic and diastolic arterial pressures. Heart rate was significantly higher in the patients group. Patients with DC demonstrated severely impaired exercise capacity, as assessed by six-minute walk test. As expected, marked differences were noted between groups in the parameters of LV remodeling, systolic and diastolic function.

There were signs of maladaptive ventricular remodeling in patients with DC - significant LV dilation and shape distortion, eccentric hypertrophy and raised end-systolic wall stress. Meridional wall stress was predominantly increased. As a result, the ratio of circumferential to meridional wall stress was reduced compared to the control. LV myocardial mass index significantly increased in the patient group. However, raised wall stress was not compensated by myocardial hypertrophy. The thickness-to-radius ratio was markedly reduced.

Table 1. Patient characteristics

Age (years) 4410 4711
Heart rate (beats/min) 758 9717 *
Atrial fibrillation 0 23% *
Systolic Arterial Pressure (mm Hg) 12212 12424
Diastolic Arterial Pressure (mm Hg) 789 8216
Six-minute walk test distance (m) 56854 21295 *
Left atrial size (mm) 336 498 *
LV End-Diastolic Volume (ml) 12214 25961 *
LV End-Systolic Volume (ml) 477 18452 *
LV Ejection Fraction (%) 623 305 *
LV systolic sphericity index 0.570.03 0.710.04 *
LV diastolic sphericity index 0.640.05 0.790.04 *
LV mass index (g/m2) 8516 16646 *
h/r ratio 0.350.04 0.280.05 *
S1 (kPa) 224 327 *
S2 (kPa) 102 194 *
S1/S2ratio 2.130.11 1.670.13 *
Isovolumic relaxation time (ms) 7410 4612 * #
Peak Velocity of Early Filling (m/s) 0.790.12 0.600.12 * #
Peak Velocity of Atrial Filling (m/s) 0.560.08 0.350.11 * #
PE/PA ratio 1.430.21 1.830.59 * #
Deceleration time of early filling (ms) 17016 11426 * #
Restrictive pattern of diastolic filling 0 71% * #
Degree of mitral regurgitation 0 1.991.33 *

Data expressed as mean value SD or percent of patients. LV, left ventricular; h/r ratio, thickness-to-radius ratio; S1, circumferential end-systolic wall stress; S2, meridional end-systolic wall stress; PE/PA ratio, ratio of early wave to atrial wave peak velocity; *p < 0.05 vs. controls. # - data on patients in sinus rhythm.

LV systolic function was significantly impaired in the patient group. LV diastolic filling was also altered in patients with DC compared with age-matched healthy individuals. PE and PA velocities were decreased. However, the PE/PA ratio was increased as a result of predominant reduction in the PA velocity. The study patients had significantly reduced isovolumic relaxation time and deceleration time of early filling when compared to normals. Therefore, patients with DC demonstrated a tendency toward a predominant early restrictive diastolic filling. Seventy one percent of patients with sinus rhythm had a restrictive pattern of LV filling in accordance with above-mentioned criteria.

Diastolic sphericity index was chosen in this study as the criterion for dividing the whole patient group into three subgroups. Patients were divided into minimal, moderate and advanced remodeling categories according to tertiles of the index: group I (index < 0.777), group II (0.778 < index < 0.803) and group III (index > 0.804). Across the tertiles there was a tendency toward an increase in the NYHA class, LV volumes and myocardial mass, meridional and circumferential end-systolic wall stress, and a decrease in exercise capacity, LV ejection fraction, and the thickness-to-radius ratio. There was also an increase in the prevalence of the restrictive pattern of LV diastolic filling and severity of mitral regurgitation.

Table 2. Clinical and hemodynamic parameters in patients with different degrees of ventricular remodeling according to the meaning of diastolic sphericity index

n 23 21 27
NYHA class 2.220.74* 2.760.83 2.890.70***
6-minute walk test distance (m) 252104 21082 17987***
Left atrial size (mm) 488 495 509
LV end-diastolic volume (ml) 21133* 25244** 30557***
LV end-systolic volume (ml) 14328* 18140** 22149***
LV ejection fraction (%) 325* 295 285***
LV mass index (g/m2) 14039* 17047 18441***
h/r ratio 0.300.05 0.290.04 0.260.05***
S1 (kPa) 305 328 345
S2 (kPa) 184 195 214***
S1/S2 ratio 1.700.13 1.670.13 1.640.13***
PE (m/s) 0,570,11 0.620.09 0.610.14
PA (m/s) 0.420.15 0.370.10 0.320.06***
PE/PA ratio 1.580.82 1.750.35 2.000.50
Restrictive pattern
of diastolic filling
48%* 84% 87%***
Degree of mitral regurgitation 1.431.16* 2.141.11 2.331.47***

Data expressed as mean value SD. NYHA, New York Heart Association; LV, left ventricular; h/r ratio, thickness-to-radius ratio; S1, circumferential end-systolic wall stress; S2, meridional end-systolic wall stress; PE, peak velocity of early filling; PA, peak velocity of atrial filling; *p < 0.05 vs. group II; **p< 0.05 vs. group III; ***p < 0.05 vs. group I.

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Nikitin, NP.; Alyavi, AL.; Goloskokova, V.; Grachev, AV.; (1998). Left Ventricular Remodeling In Dilated Cardiomyopathy: Relation To Clinical Status And Cardiac Function. Presented at INABIS '98 - 5th Internet World Congress on Biomedical Sciences at McMaster University, Canada, Dec 7-16th. Available at URL http://www.mcmaster.ca/inabis98/cvdisease/nikitin0616/index.html
© 1998 Author(s) Hold Copyright