Speckle tracking echocardiography in hypokinetic non-dilated cardiomyopathy: comparison with dilated cardiomyopathy

Abstract

Aims: Hypokinetic non-dilated cardiomyopathy (HNDC), which is determined by impaired left ventricular (LV) systolic function despite normal LV size, has been categorized as a subgroup of dilated cardiomyopathy (DCM) spectrum. Lack of data regarding advanced echocardiographic data in this population motivated us to design the present study in order to assess LV myocardial deformation properties of HNDC patients against the ones with dilated left ventricle.

Methods and results: Thirty-one HNDC patients and 23 DCM patients were enrolled in the study consecutively. Myocardial deformation parameters including global longitudinal strain, global circumferential strain, LV basal and apical rotation, LV twist, and LV mechanical dispersion were obtained with the use of two-dimensional speckle tracking-based methods in all patients. Left cardiac chamber volume was also measured using three-dimensional HeartModel application. Patients with enlarged left ventricle tend to have lower LV ejection fraction. Comparing with HNDC group, DCM patients showed worse global circumferential strain (coefficient ± standard error 3.59 ± 0.94, P < 0.001) and LV mechanical dispersion (coefficient ± standard error 16.46 ± 7.09, P = 0.02) after regression analysis, while neither the global longitudinal strain nor the LV twist was not significantly different between two study population.

Conclusions: Left ventricular enlargement has a substantial effect on the circumferential strain and mechanical dispersion more than other deformation parameters that may play a role in the assumed poor prognosis of heart failure patients with dilated left ventricle.

Keywords: DCM (dilated cardiomyopathy); GCS (global circumferential strain); GLS (global longitudinal strain); HNDC (hypokinetic non-dilated cardiomyopathy); Left ventricular mechanical dispersion; Speckle tracking echocardiography.

Figure 1

Global circumferential strain measuring from three standard short‐axis views in a patient affected by hypokinetic non‐dilated cardiomyopathy. (A)–(C) show circumferential strain at basal, mid, and apical levels of left ventricle, respectively (D) represents the circumferential strain bullseye plot with respect to the 18‐segment left ventricular model.

Figure 2

Accurate measurement of left ventricular volumes and left ventricular ejection fraction using three‐dimensional (3D) HeartModel echocardiography. ED. end‐diastolic; ES, end‐systolic; HR, heart rate.