Dynamic Left Ventricular Dyssynchrony Assessed on 3-Dimensional Speckle-Tracking Area Strain During Dobutamine Stress Has a Negative Impact on Cardiovascular Events in Patients With Idiopathic Dilated Cardiomyopathy

• Matsumoto Kensuke

  Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine

• Tanaka Hidekazu

  Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine

• Miyoshi Tatsuya

  Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine

• Hiraishi Mana

  Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine

• Kaneko Akihiro

  Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine

• Fukuda Yuko

  Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine

• Tatsumi Kazuhiro

  Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine

• Kawai Hiroya

  Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine

• Hirata Ken-ichi

  Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine

抄録

Background: Left ventricular (LV) dyssynchrony is not a stable phenomenon, but rather, changes dynamically. Given that the prognostic impact of dynamic dyssynchrony has not yet been elucidated, the objective was to investigate the clinical impact of dynamic dyssynchrony on patients with dilated cardiomyopathy (DCM). Methods and Results: Seventy DCM patients with ejection fraction 32±9% were retrospectively recruited, and 3-dimensional speckle-tracking area strain was used to measure both contractile reserve and changes in dyssynchrony during dobutamine stress. The standard deviation of time-to-peak area strain was adopted as the systolic dyssynchrony index. Event-free survival was then tracked over a 13-month period. A ≥7.55% increase in systolic dyssynchrony index during dobutamine stress (Δsystolic dyssynchrony index) was the best predictor of cardiovascular events with 77% sensitivity and 88% specificity. Multivariate Cox analysis indicated that not only the absence of contractile reserve (Δglobal area strain ≤21.1%: hazard ratio [HR], 15.29; P=0.01), but the presence of dynamic dyssynchrony (ΔLV dyssynchrony ≥7.55%: HR: 7.591; P=0.003) was an independent predictor of cardiovascular events. Importantly, absence of dynamic dyssynchrony and presence of contractile reserve were associated with the most favorable outcome (98%), whereas the reverse condition was associated with the worst outcome (20%, P<0.001). Conclusions: Dynamic dyssynchrony is a potential predictor of cardiovascular events in patients with DCM, while assessment of dynamic dyssynchrony in combination with contractile reserve may further improve prognostic risk stratification.  (Circ J 2013; 77: 1750–1759)<br>

収録刊行物

• Circulation Journal

  Circulation Journal 77 (7), 1750-1759, 2013

  一般社団法人 日本循環器学会

キーワード

• Cardiomyopathy
• Echocardiography
• Heart failure
• Outcomes
• Ventricular function

詳細情報

• CRID: 1390282680080158080
• NII論文ID: 10031173756
• NII書誌ID: AA11591968
• DOI: 10.1253/circj.cj-12-1487
• COI: 1:STN:280:DC%2BC3srisVCksw%3D%3D
• ISSN: 13474820
• ISSN: 13469843
• PubMed: 23558740
• Web Site: https://www.jstage.jst.go.jp/article/circj/77/7/77_CJ-12-1487/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2014215828
• 本文言語コード: en
• データソース種別:
  • JaLC
  • Crossref
  • PubMed
  • CiNii Articles
  • KAKEN
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