Left Ventricular End-Systolic Wall Stress is a Potent Prognostic Variable in Patients With Dilated Cardiomyopathy

Abstract

Dilated cardiomyopathy is an important cause of morbidity and mortality among patients with heart failure. Left ventricular dilation is viewed as a compensatory response to maintain stroke volume, and left ventricular dilation is directly related to the increase of wall stress. However, only a few studies have examined whether wall stress can be a prognostic variable in patients with dilated cardiomyopathy. This study was designed to elucidate whether left ventricular systolic wall stress was related to the prognosis in patients with dilated cardiomyopathy. Twenty-five normal control subjects and 68 patients with dilated cardiomyopathy participated in this study. Hemodynamic parameters and left ventricular systolic wall stress were determined using echocardiography. In addition, the extent score determined by thallium-201 myocardial scintigraphy was measured as an index of cumulative loss of myocardium. During the 53-month follow-up period, 13 patients died of cardiac events. In a stepwise multivariable analysis, end-systolic wall stress and fractional shortening were significant predictors of survival. The extent score was markedly greater in the patients who died than in alive patients. There was a significant correlation between end-systolic wall stress and extent score (r=0.501, p=0.0001). Left ventricular end-systolic wall stress is an important predictor of mortality in patients with dilated cardiomyopathy. (Jpn Circ J 1999; 63: 196 -200)

Use of Thallium-201 Myocardial Scintigraphy for the Prediction of the Response to .BETA.-Blocker Therapy in Patients With Dilated Cardiomyopathy.

“…We previously reported that left ventricular end-systolic wall stress is a potent prognostic variable in patients with DCM, 21 and in that study, left ventricular end-systolic wall stress and ES of Tl-201 scintigraphy were significantly positively correlated. 21 Doi et al 11 and Shiotani et al 12 reported that the severity of Tl-201 perfusion defects in patients with DCM is associated with a poor prognosis.…”

“…21 Doi et al 11 and Shiotani et al 12 reported that the severity of Tl-201 perfusion defects in patients with DCM is associated with a poor prognosis. Bukley et al 22 indicated that constant perfusion defects seen on thallium scans in patients with DCM might represent areas of myocardial fibrosis and scarring.…”

Predicting prognosis based on the shape of the left ventricular cavity in dilated cardiomyopathy: analysis using rate of improvement in the circle index

“…To maintain cardiac output, wall stress is increased, and, to compensate, the heart enlarges and becomes more spherical, a physical manifestation of the Laplace principle. 11 This principle appears to underlie our results, which show that the circle index was significantly lower in patients with DCM than in healthy individuals. In healthy individuals, the angle between the tangential lines was largest at the apex, and the shape became elliptical.…”

“…2 Hara et al noted that an increase in the noncontractile region of myocardial tissue may be related to an increase in left ventricular diameter. 11 This would explain the correlation between the circle index and LVD. We found the circle index useful for evaluating change in elliptical shape over time in DCM.…”

Dilated Cardiomyopathy and Myocarditis

“…The utility of end-systolic wall stress and the stress-adjusted velocity in pediatric patients has been demonstrated in those with sickle-cell anemia, anthracycline exposure, and various forms of congenital heart disease and arrhythmia [28][29][30]. LV end-systolic wall stress is predictive of outcome in adult patients with DCM [31].…”