Dilated Cardiomyopathy: Normalized Multiparametric Myocardial Strain Predicts Contractile Recovery
Matthew C Henn1, Christopher P Lawrance1, Julia Kar1
1Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri.
Insights
Dilated cardiomyopathy (DCM) shows heterogeneous injury, with basilar-septal regions most affected. High-resolution strain analysis in these sentinel regions can predict patient recovery with a two standard deviation Z-score threshold.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Dilated cardiomyopathy (DCM) presents with heterogeneous left ventricular contractile injury.
- Early-injury sentinel regions may hold prognostic value for DCM recovery.
- High-resolution contractile metrics can potentially predict recovery in DCM patients.
Purpose of the Study:
- To investigate the prognostic significance of heterogeneous left ventricular contractile injury in DCM.
- To determine if early-injury sentinel regions can predict recovery in DCM patients.
- To establish a threshold for predicting contractile recovery using high-resolution strain parameters.
Main Methods:
- Calculated 3D strain parameters from cardiac MRI in 124 subjects.
- Determined Z-scores for two strain parameters at 15,300 left ventricular grid points in 24 DCM patients.
- Averaged multiparametric strain Z-scores over 18 subregions and stratified patients by recovery.
Main Results:
- Basilar-septal subregions showed significantly higher injury (Z-scores) compared to the rest of the left ventricle and lateral wall.
- All patients (n=6) with sentinel region Z-scores < 2 standard deviations achieved complete recovery.
- 17 of 18 DCM patients with Z-scores > 2 standard deviations had incomplete or no recovery.
Conclusions:
- Left ventricular contractile injury in DCM is heterogeneous, predominantly affecting basilar-septal regions.
- Targeting early-injury sentinel regions with high-resolution metrics can accurately predict recovery.
- A two standard deviation Z-score threshold may serve as a predictor for contractile recovery in DCM.
Background:
Left ventricular contractile injury in dilated cardiomyopathy (DCM) may occur in a consistently heterogeneous distribution, suggesting that early-injury sentinel regions may have prognostic significance. Heightened surveillance of these regions with high-resolution contractile metrics may predict recovery in DCM.
Methods:
Multiple three-dimensional strain parameters were calculated at each of 15,300 left ventricular grid points from systolic displacement data obtained from cardiac magnetic resonance imaging in 124 test subjects. In 24 DCM patients, Z-scores for two strain parameters at each grid point were calculated by comparison of patient-specific strain values to respective point-specific mean and standard deviation values from a normal human strain database (n = 100). Multiparametric strain Z-scores were averaged over six left ventricular regions at basilar, mid, and apical levels (18 subregions). Patients with DCM were stratified into three groups on the basis of a blinded review of clinical contractile recovery (complete, n = 7; incomplete, n = 7; none, n = 10).
Results:
Basilar-septal subregions were consistently heavily injured. Basilar-septal Z-scores were significantly larger (worse) than those for the rest of the left ventricle (2.73 ± 1.27 versus 2.22 ± 0.83; p = 0.011) and lateral wall (2.73 ± 1.27 versus 1.44 ± 0.72; p < 0.001). All patients with sentinel region average multiparametric strain Z-scores less than two standard deviations (n = 6) experienced complete recovery, whereas 17 of 18 DCM patients with Z-scores greater than two standard deviations experienced incomplete or no contractile recovery.
Conclusions:
Contractile injury in DCM is heterogeneous, with basilar-septal regions injured more than lateral regions. The targeting of early-injury sentinel regions for heightened surveillance with high-resolution metrics of microregional contractile function may accurately predict recovery on medical therapy. A two standard deviation Z-score threshold may predict contractile recovery.
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