Echocardiography-Derived Hemodynamic Forces Are Associated with Clinical Outcomes in Patients with Non-Ischemic Dilated Cardiomyopathy

Author:

Cesareo Marco12ORCID,Ródenas-Alesina Eduard345ORCID,Guala Andrea56,Lozano-Torres Jordi3,Casas Guillem35ORCID,Vallelonga Fabrizio27ORCID,Airale Lorenzo12,Ferreira-González Ignacio348,Milan Alberto27ORCID,Rodriguez-Palomares Jose F.345ORCID

Affiliation:

1. Hypertension Unit, Division of Internal Medicine, University Hospital Città della Salute e della Scienza of Turin, Via Genova 3, 10126 Turin, Italy

2. Department of Medical Sciences, University of Turin, Via Verdi 8, 10124 Turin, Italy

3. Cardiology Department, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain

4. Department of Medicine, Universitat Autonoma de Barcelona, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain

5. Centro de Investigación Biomédica en Red-Enfermedades Cardiovaculares (CIBERCV), Av. de Monforte de Lemos, 3-5, 28029 Madrid, Spain

6. Vall d’Hebrón Research Institute (VHIR), Pg. de la Vall d’Hebron, 119-129, 08035 Barcelona, Spain

7. Division of Internal Medicine, Candiolo Cancer Institute-Fondazione del Piemonte per l’Oncologia (FPO)-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Strada Provinciale 142, KM 3.95, 10060 Turin, Italy

8. Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain

Abstract

Introduction: Non-ischemic dilated cardiomyopathy (NIDCM) is characterized by a reduced left ventricular (LV) ejection fraction (LVEF, <50%) and a high risk for heart failure (HF) and death. Echocardiography-derived hemodynamic forces (HDFs) may provide important information on LV mechanics, but their prognostic value is unknown. Aim: To explore the features of echocardiography-derived HDFs in NIDCM and their association with clinical endpoints. Methods: Asymptomatic, non-hospitalized NIDCM patients free from coronary artery disease and moderate or severe valvular heart disease were included in this single-center observational retrospective longitudinal study. Those with atrial fibrillation and a follow-up <12 months were excluded. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death, HF hospitalization, and ambulatory intravenous diuretics administration. LV HDFs were analyzed with a prototype software. Apex-base (HDFs-ab), lateral-septal (HDFs-ls), and HDFs-angle were computed. Results: Ninety-seven patients were included, sixty-seven (69%) were males, mean age was 62 ± 14 years, and mean LVEF was 39.2 ± 8.6%. During a median follow-up of 4.2 (3.1–5.1) years, 19 (20%) patients experienced MACE. These patients had a higher HDFs-angle (71.0 (67.0–75.0) vs. 68.0 (63.0–71.0)°, p = 0.005), lower HDFs-ls (1.36 (1.01–1.85) vs. 1.66 ([1.28–2.04])%, p = 0.015), but similar HDFs-ab (5.02 (4.39–6.34) vs. 5.66 (4.53–6.78)%, p = 0.375) compared to those without MACE. in a Cox regression analysis, HDFs-angle (HR 1.16 (95%-CI 1.04–1.30), p = 0.007) was associated with MACE, while other conventional echocardiography parameters, including LVEF and LV longitudinal strain, were not. Conclusions: HDFs-angle is associated with clinical endpoints in NIDCM. A higher HDFs-angle may be a marker of impaired myocardial performance in patients with reduced LVEF.

Funder

“La Caixa” Foundation

Publisher

MDPI AG

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