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Left ventricular end-systolic wall stress is a potent prognostic variable in patients with dilated cardiomyopathy
1The Second Department of Internal Medicine, Ehime University School of Medicine, Japan. yujihara@m.ehime-u.ac.jp
Insights
Left ventricular end-systolic wall stress is a significant predictor of mortality in dilated cardiomyopathy patients. Higher wall stress and myocardial damage correlate with increased cardiac event risk, aiding prognosis assessment.
Area of Science:
- Cardiology
- Cardiovascular Research
- Heart Failure Studies
Background:
- Dilated cardiomyopathy is a major cause of heart failure morbidity and mortality.
- Left ventricular dilation, a compensatory mechanism, increases wall stress.
- The prognostic value of wall stress in dilated cardiomyopathy remains under-investigated.
Purpose of the Study:
- To determine if left ventricular systolic wall stress predicts prognosis in dilated cardiomyopathy patients.
- To investigate the relationship between wall stress, myocardial damage, and survival outcomes.
Main Methods:
- Echocardiography was used to assess hemodynamic parameters and left ventricular systolic wall stress.
- Thallium-201 myocardial scintigraphy determined the extent score, an index of myocardial loss.
- A 53-month follow-up evaluated cardiac events and mortality in 68 dilated cardiomyopathy patients and 25 controls.
Main Results:
- End-systolic wall stress and fractional shortening were significant predictors of survival in multivariable analysis.
- Patients who died had a markedly greater extent score compared to survivors.
- A significant correlation (r=0.501, p=0.0001) was found between end-systolic wall stress and extent score.
Conclusions:
- Left ventricular end-systolic wall stress is a crucial predictor of mortality in dilated cardiomyopathy.
- Assessing wall stress alongside myocardial damage provides valuable prognostic information.
- These findings highlight the importance of evaluating mechanical load for risk stratification in heart failure.
Abstract:
Dilated cardiomyopathy is an important cause of morbidity and mortality among patients with heart failure. Left ventricular dilation is viewed as a compensatory response to maintain stroke volume, and left ventricular dilation is directly related to the increase of wall stress. However, only a few studies have examined whether wall stress can be a prognostic variable in patients with dilated cardiomyopathy. This study was designed to elucidate whether left ventricular systolic wall stress was related to the prognosis in patients with dilated cardiomyopathy. Twenty-five normal control subjects and 68 patients with dilated cardiomyopathy participated in this study. Hemodynamic parameters and left ventricular systolic wall stress were determined using echocardiography. In addition, the extent score determined by thallium-201 myocardial scintigraphy was measured as an index of cumulative loss of myocardium. During the 53-month follow-up period, 13 patients died of cardiac events. In a stepwise multivariable analysis, end-systolic wall stress and fractional shortening were significant predictors of survival. The extent score was markedly greater in the patients who died than in alive patients. There was a significant correlation between end-systolic wall stress and extent score (r=0.501, p=0.0001). Left ventricular end-systolic wall stress is an important predictor of mortality in patients with dilated cardiomyopathy.