Background: This study was to evaluate the relation between ultrasonic tissue characterization by integrated backscatter (IBS) imaging and multidirectional myocardial function assessed by 2-D speckled tracking imaging for prediction of LV reverse remodeling in patients with non-ischemic dilated cardiomyopathy (DCM).
Methods: Consecutive patients with heart failure and non-ischemic DCM were prospectively enrolled. The IBS intensity at the mid-basal septum and posterior wall were obtained using Echopac PC. Mean cyclic variation of IBS (CVIBS) was determined as the mean of the difference between maximal and minimal values in a cardiac cycle in the septal and posterior wall. LV longitudinal peak strain (ε) was calculated as the mean of global longitudinal end-systolic peak ε from apical 4- and 2-chambers. Mean LV circumferential and radial end-systolic peak ε were defined as then mean ε from the 18 segments of basal, mid and apical parasternal short axis. LV torsion was defined as the difference of LV apical and basal rotation. Reverse remodeling was defined as increase in LVEF by at least 20% and decrease in LV end-systolic volume by at least 15% with respect to baseline in 12 months.
Results: Thirty-three patients were analyzed for this study. Eighteen patients showed LV reverse remodeling (Group1) and 15 patients showed no LV reverse remodeling (Group2). LV longitudinal, mean circumferential and radial ε were well correlated to mean CVIBS (r=-0.37, p=0.04; r=0.50, p=0.005; r=-0.46, p=0.01, respectively) and mean circumferential ε was most related to CVIBS. However, LV torsion and apical radial ε were not related to mean CV. Mean CVIBS and circumferential ε, but not longitudinal and LV torsion were larger in Group1 than Group2 (Table). Radial ε except apical ε was also larger in Group1 than Group 2 (all p<0.05). The sensitivity and specificity to predict LV reverse remodeling were 72.2% and 80.0% with cutoff value of 5.53dB for mean CVIBS, and 88.9% and 46.7% with cutoff value of -5.88% for mean circumferential ε, respectively.
Conclusion: Myocardial fibrosis assessed by IBS was associated with LV longitudinal, circumferential and radial deformation, but not torsion in patients with DCM. LV reverse remodeling was related to LV circumferential and radial ε, but not with longitudinal ε and torsion and can be best predicted by circumferential ε in patients with DCM.
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