Abstract

Introduction

Materials & Methods

Results

Discussion & Conclusion

References

Discussion
Board

Table 1 summarizes the clinical, echocardiographic and Doppler data in patients with DC and control subjects. There was no significant differences between the two groups in age, systolic and diastolic arterial pressures. Heart rate was significantly higher in the patients group. Patients with DC demonstrated severely impaired exercise capacity, as assessed by six-minute walk test. As expected, marked differences were noted between groups in the parameters of LV remodeling, systolic and diastolic function.

There were signs of maladaptive ventricular remodeling in patients with DC - significant LV dilation and shape distortion, eccentric hypertrophy and raised end-systolic wall stress. Meridional wall stress was predominantly increased. As a result, the ratio of circumferential to meridional wall stress was reduced compared to the control. LV myocardial mass index significantly increased in the patient group. However, raised wall stress was not compensated by myocardial hypertrophy. The thickness-to-radius ratio was markedly reduced.

Table 1. Patient characteristics

LV systolic function was significantly impaired in the patient group. LV diastolic filling was also altered in patients with DC compared with age-matched healthy individuals. PE and PA velocities were decreased. However, the PE/PA ratio was increased as a result of predominant reduction in the PA velocity. The study patients had significantly reduced isovolumic relaxation time and deceleration time of early filling when compared to normals. Therefore, patients with DC demonstrated a tendency toward a predominant early restrictive diastolic filling. Seventy one percent of patients with sinus rhythm had a restrictive pattern of LV filling in accordance with above-mentioned criteria.

Diastolic sphericity index was chosen in this study as the criterion for dividing the whole patient group into three subgroups. Patients were divided into minimal, moderate and advanced remodeling categories according to tertiles of the index: group I (index < 0.777), group II (0.778 < index < 0.803) and group III (index > 0.804). Across the tertiles there was a tendency toward an increase in the NYHA class, LV volumes and myocardial mass, meridional and circumferential end-systolic wall stress, and a decrease in exercise capacity, LV ejection fraction, and the thickness-to-radius ratio. There was also an increase in the prevalence of the restrictive pattern of LV diastolic filling and severity of mitral regurgitation.

Table 2. Clinical and hemodynamic parameters in patients with different degrees of ventricular remodeling according to the meaning of diastolic sphericity index

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