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Segmental wall motion abnormalities in dilated cardiomyopathy: hemodynamic characteristics and comparison with
Insights
Dilated cardiomyopathy (DCM) shows varied left ventricular wall motion. Diffuse wall motion abnormality in DCM is linked to higher pressures and volumes, suggesting fibrosis may cause regional issues.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Physiology
Background:
- Dilated cardiomyopathy (DCM) is characterized by impaired left ventricular function.
- Understanding regional wall motion abnormalities is crucial for DCM assessment.
- Thallium-201 myocardial scintigraphy (MPI) assesses myocardial perfusion and viability.
Purpose of the Study:
- To evaluate hemodynamic characteristics of left ventricular segmental wall motion abnormalities in DCM.
- To correlate these abnormalities with thallium-201 myocardial scintigraphy findings.
- To differentiate between segmental and diffuse wall motion abnormalities in DCM patients.
Main Methods:
- Quantitative analysis of left ventriculograms and MPI in 23 DCM patients.
- Assessment of regional wall motion and TI-201 uptake using defined indexes.
- Comparison of hemodynamic parameters between patients with segmental (SWMA) and diffuse (DWMA) wall motion abnormalities.
Main Results:
- Inferior wall normokinesis was more frequent than anterior wall normokinesis (p<0.01).
- Severe asynergy was more common in the anterior wall than the inferior wall (p<0.01).
- DWMA group exhibited higher left ventricular end-diastolic pressures (p<0.05) and larger end-diastolic volumes than SWMA group.
- A correlation (r=0.58) was observed between TI-201 uptake and regional wall motion.
- Worse TI-201 uptake correlated with more severe regional asynergy.
Conclusions:
- Nonuniformity of left ventricular wall motion is a feature of DCM.
- Increased preload is associated with diffuse wall motion abnormalities in DCM.
- Regional asynergy in DCM may be linked to localized myocardial fibrosis, indicated by impaired TI-201 uptake.
Abstract:
This study assessed the hemodynamic characteristics of segmental wall motion abnormality of the left ventricle in patients with dilated cardiomyopathy (DCM) and its relation to the thallium-201 (TI-201) myocardial scintigraphy (MPI). Left ventriculograms and MPI in 23 patients were analyzed by the use of quantitative indexes of regional wall motion and TI-201 uptake based on a mean and a standard deviation of 13 normal subjects. Relative normokinesis in our definition was more frequently seen in the inferior wall than in the anterior wall (p less than 0.01). In contrast, severe asynergy was more often seen in the anterior wall than in the inferior wall (p less than 0.01). There were 11 patients who had relative normokinesis and asynergy together. By means of the index of wall motion, the DCM patients were divided into two groups, one with segmental wall motion abnormality (SWMA) and another with diffuse wall motion abnormality (DWMA). The DWMA group had higher left ventricular end-diastolic pressures (p less than 0.05) and the tendency of large left ventricular end-diastolic volumes than the SWMA group. There was a rough correlation (r = 0.58) between the quantitative indexes of TI-201 uptake and wall motion at the same region of the left ventricle. Thus, the nonuniformity of the left ventricular wall motion was recognized in the patients with DCM and more increased preload was shown in the patients with DWMA than in the group with SWMA. Further, the regional asynergy may be related to the localized fibrosis within the left ventricle in DCM, considering the result that the worse TI-201 uptake was roughly accompanied by the more severe asynergy.