Key result
Patients with dilated cardiomyopathy exhibited significantly reduced longitudinal and circumferential strain across all three myocardial layers, with diffuse impairment of microcirculation perfusion compared to healthy controls.
Why the study?
To investigate changes in left ventricular three-layer myocardial deformation and microcirculation perfusion in patients with DCM using STI and MCE.
Are layer-specific strain and myocardial microcirculation perfusion altered in patients with dilated cardiomyopathy compared to healthy controls?
Case-Control (n=43)
No
Are layer-specific strain and myocardial microcirculation perfusion altered in patients with dilated cardiomyopathy compared to healthy controls?
Absolute Event Rate: -9.8% vs -20.65%
p-value: p=<0.001
In patients with dilated cardiomyopathy, both myocardial deformation and microvascular perfusion are diffusely impaired across all myocardial layers, with longitudinal function closely related to microcirculation changes.
Diffuse strain and perfusion deficits in DCM merit prospective evaluation; leaves open prognostic or therapeutic utility.
BackgroundTo investigate the changes in deformation and myocardial microcirculation perfusion of left ventricular three-layer myocardium in patients with dilated cardiomyopathy (DCM) by using speckle tracking imaging (STI) and myocardial contrast echocardiography (MCE).MethodsTwenty-four patients with DCM and 19 healthy controls were selected. Two-dimensional and MCE dynamic images of apical four-chamber, two-chamber, and three-chamber sections and left ventricular mitral valve, papillary muscle and apex sections were collected. The peak values of longitudinal strain (LS), circumferential strain (CS), cross-sectional area of a microvessel (A) and average myocardial microvascular lesion (β) were obtained by Qlab 10.8 workstation values, and myocardial blood flow (MBF) was calculated with A×β to evaluate the deformation and coronary microvascular perfusion of left ventricular three-layer myocardium.ResultsThe brain natriuretic peptide (BNP), left ventricular mass index (LVMI), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVEDS), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left atrial volume index (LAVI), E peak in early diastolic period/A peak velocity in late diastolic period (E/A) and average E/e' in the DCM group were higher than those in the control group ( P < 0.05); left ventricular ejection fraction (LVEF), left ventricular fractional shortening (FS) rate, stroke volume (SV), cardiac output (CO), cardiac index (CI), A peak, and the e' and a' velocities of both the lateral wall and interventricular septum were smaller than those in the control group ( P <0.05). The LS, CS, A, β, and A×β of the DCM group were all lower than those of the control group ( P < 0.05). The pattern of myocardial strain and perfusion among myocardial layers was subendocardial>middle>subepicardial. The correlation coefficients of LS with A, β, and A×β were -0.500, -0.279 and -0.190, respectively, and the correlation coefficients of CS with A, β, and A×β were -0.383, -0.255 and -0.208, respectively.ConclusionsThe deformation of the three-layer myocardium and coronary microcirculation perfusion in DCM patients were diffusely damaged from the endocardium to the epicardium, layer by layer. The longitudinal function of the left ventricular myocardium was closely related to changes in myocardial microcirculation perfusion.
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Tang et al. (2021) conducted a case-control in Dilated cardiomyopathy (n=43). Dilated cardiomyopathy vs. Healthy controls was evaluated on Endocardial longitudinal strain (LSendo) (p=<0.001). Patients with dilated cardiomyopathy exhibited significantly reduced longitudinal and circumferential strain across all three myocardial layers, with diffuse impairment of microcirculation perfusion compared to healthy controls.
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