P354Speckle tracking study in dilated ischemic and idiopatic cardiomyopathy with low ejection fraction: different ventricular and atrial impairment

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Purpose: Heart failure patients (pts) with same ejection fraction have different symptoms, morbidity and mortality.Speckle tracking echocardiography was used to recognize ventricular and atrial myocardial function differences between ischemic and idiopatic cardiomyopathy.Methods: 100 subjects: 25 (mean age:62 years) pts with ischemic cardiomyopathy (group A), 25 with idiopatic cardiomiopathy (negative coronary angiography) (group B) and 50 healthy controls (group C) were studied. All pts underwent coronary angiography except controls and all had left ventricular(LV) ejection fraction(EF)≤35%. By System Seven GE with TVI, atrial and ventricular diameters, volumes, EF, propagation velocity(Vp) and E/Vp ratio were measured. Pulmonary wedge capillary pressure(PWCP) was calculated by E/Ea. Bidimensional acquisitions were analyzed to measure longitudinal peak systolic ventricular (all segments), atrial (global) S and SR in apical 4 and 2-chambers views and circumferential and radial systolic S and SR in middle short axis view.Results: Group A and B pts showed impaired diastolic function by PW Doppler, TVI, Vp and E/Vp (group A=3,561±0,66; group B=2,44±0,7); they had high PWCP (group A=20,1±3,66; group B=14,4±5,3). Group A (S= 7,6±4,6%; SR=0,57±0,16S-1) and B (S= 14,27±5,2%; SR=0,82±0,4S-1) pts had lower atrial longitudinal systolic S and SR than controls (S=33±7%; SR=2,37±0,63 S-1). Pts showed lower ventricular radial systolic S (group A:11,69±8,5%; group B:14,88±9,36) and SR (group A:0,94±0,33; group B:1,25±0,69;) than in controls (S=46,3±9,4%9; SR=1,58±0,51S-1). Ventricular 2D longitudinal systolic S and SR, for each segment, were impaired in group A (average S=-6,21±5,33%;SR=-0,61±0,34S-1) and B (average S=-10,89±6,17%;SR=-0,8±0,48S-1). Ventricular circumferential S and SR were impaired in group A (S=-7,9±6,24%;SR=-0,74±0,26S-1) and group B pts (S=-9,86±6,27%;SR=-0,87±0,44S-1). An inverse correlation (r = -0,78) was found between PWCP and atrial S. Significant differences were found between group A and B pts for atrial longitudinal S and SR, ventricular longitudinal S, ventricular circumferential SR, with lower values in group A pts and for PWCP, higher in group A. Conclusions: Myocardial deformation properties are impaired in both ischemic and non ischemic heart failure pts. Ischemic pts have significant lower atrial longitudinal S and SR values and higher PCWP values. Higher PWCP values are associated with greater atrial S impairment.

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