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ȣ - 530683 86 |
| Potential Influence Of Left Atrial Size On Longitudinal Tissue Velocity In Assessing Myocardial Function Of Patients With Duchenne Muscular Dystrophy |
| 연세대학교 의과대학 강남 세브란스 병원 심장내과 |
| 심재민, 이혜영, 엄숙정, 최의영, 김종윤, 민필기, 윤영원, 이병권, 홍범기, 임세중, 권혁문 |
Background: Patients with dilated cardiomyopathy (DCM) due to Duchenne muscular dystrophy (DMD) have very low body mass, smaller left atrial size, lower plasma BNP and less heart failure symptoms, compared to patients with idiopathic DCM. Despite myocardial longitudinal velocity has been shown to provide index of systolic and diastolic function, influence of LA geometry has not been fully studied yet. In this study, we hypothesized that not only myocardial function but geometric characteristics may influence the longitudinal tissue Doppler velocity.
Methods: Twenty three DMD patients (all males, 21.2±4.3 years) with LVEF < 40 % and the same number of sex-matched idiopathic DCM patients were studied with echocardiography. Standard echocardiographic measurements of left ventricular (LV) systolic and diastolic function were performed. Mitral septal annular systolic (S’) and early diastolic (E’) velocities that reflect systolic and diastolic longitudinal function were measured using tissue Doppler imaging.
Results: There were no significant differences in systolic blood pressure, diastolic blood pressure, LV ejection fraction, LV end systolic dimension index and LV end diastolic dimension index. S’ and E’ were significantly higher in DMD patients compared with idiopathic DCM patients (5.57 ± 0.88 cm/sec vs 4.05 ± 1.26 cm/sec, p < 0.001 and 7.08 ± 1.31 cm/sec vs 4.21 ± 1.83 cm/sec, p < 0.001, respectively). Left atrial volume index (LAVI) was significantly lower in patients with DMD (20.4 ± 13.2 ㎖/m2 vs 45.5 ± 26.0 ㎖/m2, p < 0.001). Furthermore, S’ and E’ were significantly related to LAVI (p = 0.028 for S’ and p = 0.001 for E’) and LAVI was an independent predictor of S’ and E’ in multivariate analysis (p = 0.001).
Conclusions: Patients with DCM associated with DMD have relatively preserved myocardial longitudinal function assessed by tissue Doppler. Longitudinal systolic and diastolic tissue Doppler velocities were significantly affected by LA size. Limitation of longitudinal motion of mitral annulus due to increased LA may be related to the decreased myocardial longitudinal velocity.
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