EFFECT OF AROTINOLOL ON LEFT VENTRICULAR FUNCTION IN PATIENTS WITH IDIOPATHIC DILATED CARDIOMYOPATHY

Objective To evaluate the efficacy and safety of long-term treatment with arotinolol in patients with idiopathic dilated cardiomyopathy(IDCM).Methods Sixty-three patients with IDCM were evaluated at baseline and after 12-month therapy with arotinolol.The conventional therapy for congestive heart failure was continued throughout the study with arotinolol as the only β-blocker.Left ventricular function was assessed with the New York Heart Association functional class and two-dimensional echocardiography.Results After 12-month arotinolol treatment,there was a significant improvement in left ventricular systolic function.Left ventricular end-systolic dimension significantly decreased from 59.52±8.83 mm to 50.89±8.17 mm(P<0.001).Left ventricular ejection fraction significantly increased from 27.39%±7.94% to 41.13%±9.45%(P<0.001).Left ventricular mass index decreased from 150.47±42.42 g/m2 to 141.58±34.36 g/m2(P<0.01).No adverse events leading to premature discontinuation of study drug occurred.Conclusion In this preliminary study,12-month arotinolol treatment has a favorable effect on left ventricular function in patients with IDCM,and it is safe and well tolerated.

Cytotoxic T lymphocyte associated antigen-4 gene exon 1A49→G polymorphisms confer susceptibility to idiopathic dilated cardiomyopathy

Autoimmune mechanisms, including cellular and humoral immune, are likely to participate in the pathogenesis of at least a subgroup of idiopathic dilated cardiomyopathy （IDC）, in which cellular immune-mediation plays a more important role. Cytotoxic T lymphocyte associated antigen-4 （CTLA-4） is the major negative regulatory factor of cellular immunity. This study was conducted to investigate the association of CTIA-4 gene exon 1 A49→G polymorphism with susceptibility to IDC in Han Chinese and its influences on serum soluble CTIA-4 （sCrLA-4） and Th1/Th2 cytokine bias. Polymerase chain reaction-restriction fragment length polymorphism （PCR-RFLP） techniques were used to analyze the dimorphism of CTL4-4 exon 1 in the unrelated Han ethnic population in Heilongjiang Province （ including 48 IDC patients and 50 normal controls）. Serum sCTLA-4, IFN-γ and IL-4 were evaluated by ELISA, with the ratio of IFN-γ/IL-4 as indicator for Th1/Th2 bias. Compared with controls, the frequencies of GG genotype （0.6042 and 0.3600, P = 0.012） and the G allele （0.7396 and 0.5600, P = 0.008） were significantly increased in IDC patients. Increased serum sCTIA-4 was found in the 1DC group compared with the controls [ （ 1.87 ± 1.06） μg/L vs. （0.54 ± 0.19） 〉g/L, P 〈 0.05 ~. 1FN-7 was much lower in IDC patients than that of the controls [ （ 16.38 ± 6.25） ng/L vs. （29.81 ± 10.66） ng/L （P 〈 0.05）~., whereas no statistical difference of IL-4 was found between the two groups I （12.85 ± 1.86） ng/L vs. （12.11 ± 2.76） ng/L], so the ratio of IFN-γ/IL-4 declined significantly （ 1.63 ± 0.50 vs. 3.01 ± 0.89, P 〈 0.05）. Linear regression analysis manifested a significant interrelationship between the GG genotype, G allele frequencies and serum sCTLA-4, IFN-γ/IL-4 in the IDC group （ r = 0.57, P = 0. 021 and r = 0.32, P = 0. 036）. CTLA-4 gene A49→G substitution was associated with an increased IDC risk, which implicated that the CTLA-4 gene exon 1 may have a considerable role in autoimmune cardiac damage, possibly via a Thr→Ala change in signal peptide, which influences the protein synthesis and modification processes, with a result of functional alteration of sCTLA-4. The bias of Th1/Th2 paradigm was associated with the increased sCTIA-4 under certain background of immunogenetics.

HLA-DQA1 Polymorphism in Idiopathic Dilated Cardiomyopathy

To determine whether the possession of certain HLA-DQA1 alleles was associated with the risk of developing idiopathic dilated cardiomyopathy (IDC) and to substantiate the role of an autoimmunologic pathogenesis in IDC. Type the alleles of HLA-DQA1 by polymerase chain reaction with sequence-specific primers (PCR-SSP) technique in 38 patients of idiopathic dilated cardiomyopathy (7 women and 31 men), aged from 17 to 56 years old with diagnosis being according to World Health Organization criteria (IDC group), in 50 patients of end-stage heart failure of known etiology (18 women and 32 men), with ages ranging from 34 to 72(HF group), and in the control group consisting of presumably 100 healthy subjects (39 women and 61 men) from the health survey, aged from 30 to 59 years old. The frequency of HLA-DQA1*0501 in the DCM patients was significantly elevated than that in the HF and the control group. Molecular analysis of the DQA1 gene polymorphism performed in the three subgroups shows an increased frequency of DQA1*0501 among patients with less EF. The HF group carries a high frequency of HLA-DQA1*0301. An increased frequency of DQA1*0201 and DQA1*0103 was found in the control group. HLA-DQA1*0501 is an associated gene of idiopathic dilated cardiomyopathy and the possession of DQA1*0301 may be indicative of the known etiologic heart failure, suggesting that the mechanisms involved in the pathogenesis of IDC and otherwise heart failure are different. Immunologic abnormalities may be a major contributor to the susceptibility of developing of IDC.

D-dimer level and long-term outcome in patients with end-stage heart failure secondary to idiopathic dilated cardiomyopathy

Background Previous studies had demonstrated hemostatic abnormalities in patients with heart failure (HF) and several studies have shown that abnormal coagulation indices, represented by elevated D-dimer, had prognostic significance in patients with compatible or acute decompensated HF. However, the impact of D-dimer on the outcome in patients with end-stage HF remains unclear. Methods A total of 244 consecutive patients with end-stage HF due to idiopathic dilated cardiomyopathy (DCM) were prospectively enrolled from February 2011 to September 2014. D-dimer levels were measured and its prognostic value was assessed. Primary endpoint was all-cause mortality during the follow-up period. Secondary endpoints were stroke, bleeding, occurrence of sustained ventricular tachycardia or ventricular fibrillation, and major adverse cardiovascular events (MACE). Results D-dimer was significantly elevated in the non-survivors (median: 0.8 vs. 1.1 mg/L, P < 0.001). Traditional markers including B-type natriuretic peptide, troponin I, left ventricular ejection fraction, and left ventricular end-diastolic dimension provided limited prognostic value;but the addition of D-dimer refined the risk stratification. The optimal cut-off value of D-dimer to predict all-cause mortality was 0.84 mg/L by receiver operator characteristic analysis. Elevated D-dimer level was independently associated with increased risk of long-term all-cause mortality (HR = 2.315, 95% CI: 1.570–3.414, P < 0.001) and MACE (HR = 1.256, 95% CI: 1.058–1.490, P = 0.009), and the predictive value was independent of age, sex, atrial fibrillation and anticoagulation status. Conclusions Elevated D-dimer level was independently associated with poor long-term outcome in patients with end-stage HF secondary to idiopathic DCM, and the predictive value was superior to that of traditional prognostic markers.

Clinical characteristics, treatment and prognosis of patients with idiopathic dilated cardiomyopathy: a tertiary center experience

Background Contemporary heart failure medications have led to considerable improvement in the survival of patients with heart failure. However,limited evidence is available regarding the effect of those medications in patients with idiopathic dilated cardiomyopathy (IDCM),particularly in China. We sought to analyze the trends in clinical characteristics and the prescription rate of recommended therapies and its prognostic impact in patients with IDCM. Methods From 2009 to 2016,1441 consecutive patients (age: 55±14 years,68% men,LVEF: 33%± 12%) fulfilling World Health Organization criteria for IDCM were enrolled in the current retrospective cohort study. Temporal trends of baseline clinical characteristics,treatment and prognosis were analyzed,and potential influential factors were explored. Results Rates of patients receiving angiotensin-converting enzyme inhibitors/angiotensin II receptors blockers,β-blockers,aldosterone receptor antagonists and diuretics increased from 55%,45%,58%,51% in 2009 to 67%,69%,71%,64% in 2016,respectively (P < 0.05);whereas,the proportion of patients receiving digoxin decreased from 39% in 2009 to 28% in 2016 (P < 0.05). The overall proportion of patients with optimal guideline-directed medical therapy (GDMT) was 44.6%;however,that rate increased from 33% in 2009 to 41%,49% and 56% in 2012,2014 and 2016 respectively (P < 0.05). Patients with optimal GDMT had a better outcome than those without,but there was no temporal trend toward improvement in the overall long-term prognosis of IDCM patients with the years. There was a trend towards admission of patients with milder disease and toward increased admission to a cardiology ward with the years. Conclusions An improvement in prescription rates of guideline-recommended medications in IDCM patients was observed. However,it remains suboptimal,and there is still some room for improvement. The prognosis of patients with optimal GDMT was better than those without. Moreover,the following patient category also had an improved prognosis: patients with LVEF ≥ 40%,with device therapy,and those admitted to a cardiology ward.

Impact of Left Bundle Branch Block on Left Ventricular Mechanics in Patients with Idiopathic Dilated Cardiomyopathy

Objectives: Left bundle branch block (LBBB) is commonly associated with heart failure. We evaluated the prevalence and impact of LBBB on left ventricular mechanics using 2D strain imaging in patients with idiopathic dilated cardiomyopathy (IDCM). Methods: We included 101 patients with IDCM with mean age 38 ± 18 years: 74% were males and 13.9% of them were in NYHA Class III-IV. LBBB was present in 26 (37%) of included patients. Myocardial mechanics including longitudinal, circumferential strain and rotation and LV synchronization were assessed using two-dimensional strain imaging. Results: LBBB group had higher LV volumes, and PAP compared with non LBBB. Peak LV longitudinal systolic strain (εsys) of the septum and global LV SRsys were significantly lower in LBBB compared to non LBBB group (P 0.01, 0.03). TTP-d was greater in LBBB in comparison to non LBBB group (274.5 ± 116 versus 209.4 ± 139, P 0.02). The electromechanical delay between septal segments was 35 ± 18 ms and between lateral wall segments: 48 ± 24 ms, between anterior wall segments: 21 ± 11 and between inferior wall segments: 41 ± 12. Consequently, LV mechanical dyssynchrony was more evident in IDCM patients with LBBB. QRS width was correlated inversely with LV longitudinal strain and strain rate and electromechanical delay (P 0.0001) in non LBBB group. In LBBB QRS width was not related to cardiac mechanics. Using univariate analysis and after a multiple covariate adjustment, the baseline LBBB was associated with a significantly increased LV dysfunction. Conclusion:After correcting for potential confounders, LBBB was found to be associated with more deterioration of LV mechanics and exaggerated LV dyssynchrony in patients with IDCM.

Modified Batista Procedure for Idiopathic Dilated Cardiomyopathy: Report of a Case

The surgical indications for dilated cardiomyopathy (DCM) remain controversial, not including cardiac transplantation and mechanical circulatory support. We describe a case of idiopathic DCM that underwent successful surgical treatment using a modified left ventriculectomy, modification of the Batista procedure. The patient was a 63-year-old man who suffered from heart failure, New York Heart Association (NYHA) Class IV. Heart failure was derived from idiopathic DCM with a severely compromised left ventricular function complicated by left ventricular thrombosis. He underwent successful surgical treatment, specifically partial left ventriculectomy combined with the papillary muscle approximation, and the postoperative course was uneventful. He has been well with NYHA Class I for 3 years after the operation without heart failure.

Polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes syndrome with dilated cardiomyopathy: A case report

BACKGROUND Polyneuropathy,organomegaly,endocrinopathy,M-protein,skin changes(POEMS)syndrome is a rare paraneoplastic syndrome that encompass multiple systems.The most common clinical symptoms of POEMS syndrome are pro-gressive sensorimotor polyneuropathy,organ enlargement,endocrine disorders,darkening skin,a monoclonal plasma cell proliferative disorder,and lymph node hyperplasia.The organomegaly consists of hepatosplenomegaly and/or lym-phadenopathy;cases of cardiomyopathy are rare.Diagnoses are often delayed because of the atypical nature of the syndrome,exposing patients to possibly severe disability.Therefore,identifying atypical symptoms can improve the prognosis and quality of life among POEMS syndrome patients.lenalidomide and dexamethasone.CONCLUSION When patients with cardiomyopathy have systemic manifestations such as numb limbs and darkening skin,the POEMS syndrome is the most possible diagnosis.

Bioinformatics Analysis of the Relationship between Dilated Cardiomyopathy and Chronic Heart Failure

Objective: To screen and analyze the differentially expressed genes between dilated cardiomyopathy (DCM) and chronic heart failure (CHF) based on bioinformatics methods. Methods: The Gene Expression Omnibus (GEO) database was used for data retrieval, and the chip data GSE3585 was downloaded, which was the original data of DCM and normal control group. At the same time, the chip data GSE76701 was downloaded, which was the original data of CHF and control group. Differentially expressed mRNAs (DEmRNAs) were screened by R language limma package, the data were standardized, and the common differentially expressed genes were screened. GO function and KEGG pathway enrichment analysis were performed on the common differentially expressed genes. String11.0 online tool was used for data analysis to obtain differentially expressed genes, and the results were imported into Cytoscape 3.9.1 software. The results were imported into Cytoscape 3.9.1 software, and the common expression gene module was obtained by MOCDE algorithm. Nine Hub genes were obtained by 10 algorithms such as MCC. Results: A total of 248 differentially expressed genes were screened. GO analysis showed that differentially expressed genes were mainly concentrated in 9 different physiological and pathological processes. KEGG analysis showed that the main signaling pathways involved in differentially expressed genes were 2, and 9 key differentially expressed genes were predicted: NPPB, NPPA, MYH6, FRZB, ASPN, SFRP4, RPS4Y1, DDX3Y. Conclusion: This study preliminarily explored the molecular mechanism of DCM and CHF, and obtained the common differentially expressed genes of the two diseases. Further experimental studies are needed to verify the correlation between gene expression and clinicopathological features. Provide new ideas for clinical drug treatment research.

Construction of A Prediction Model for Atrial Fibrillation in Patients with Dilated Cardiomyopathy and Heart Failure

Dilated cardiomyopathy(DCM)is a common myocardial disease characterized by enlargement of the heart cavity and decreased systolic function,often leading to heart failure(HF)and arrhythmia.The occurrence of atrial fibrillation(AF)is closely related to the progression and prognosis of the disease.In recent years,with the advancement of medical imaging and biomarkers,models for predicting the occurrence of AF in DCM patients have gradually become a research hotspot.This article aims to review the current situation of AF in DCM patients and explore the importance and possible methods of constructing predictive models to provide reference for clinical prevention and treatment.We comprehensively analyzed the risk factors for AF in DCM patients from epidemiological data,pathophysiological mechanisms,clinical and laboratory indicators,electrocardiogram and imaging parameters,and biomarkers,and evaluated the effectiveness of existing predictive models.Through analysis of existing literature and research,this article proposes a predictive model that integrates multiple parameters to improve the accuracy of predicting AF in DCM patients and provide a scientific basis for personalized treatment.

Mechanism of Anti-β-adrenoceptor Antibody Mediated Myocardial Damage in Dilated Cardiomyopathy

Antibodies against &-adrenoceptor can be detected in serum of patients with dilated cardiomyopathy (DCM), which have 5-agonist-like activity, and induce a positive chronotropic effect on cardiac myocytes by its persistence at full strength. Effects of the antibodies against Padrenoceptor from sera of patients with DCM on myocardial cytotoxicity and cytoplasmic free Ca2+-concentration (LCa2+ji) were observed in the cultured single layer SD rat ventricular cells by using the cytotoxicity assay and fluorescent Ca2+- indicat0r fura-2/AM. The positive sera of the anti-&adrenoceptor antibodies from patients with DCM markedly enhanced myocardial [Ca2+]i. Betaloc, a 5, -receptor blocker, might inhibit the increase of the antibody-mediated myocardial [Ca2+]i, and the sera from healthy donors had no effect on myocardial [Ca2+]i,. Our results suggest that the anti-β-adrenoceptor antibody might increase myocardial [Ca2+]i, and result in myocardial damage. The antibodies might activate receptor-gating Ca2+-channel, thereby causing myocardial [Ca2+]i, rise and calcium overload. Early use of betaloc is recommended in the treatment of dilated cardiomyopathy.

Prognostic Value of Feature-Tracking Circumferential Strain in Dilated Cardiomyopathy Patients with Severely Reduced Ejection Fraction Incremental to Late Gadolinium Enhancement

Myocardial fiber deformation measurements have been reported to be associated with adverse outcomes in patients with acute heart failure and those with myocardial infarction.However,few studies have addressed the prognostic value of global circumferential strain(GCS)in dilated cardiomyopathy(DCM)patients with severely impaired systolic function.This study aimed to evaluate the prognostic value of cardiac magnetic resonance(CMR)-derived GCS in DCM patients with severely reduced ejection.Consecutive DCM patients with severely reduced ejection fraction(EF<35%)who underwent CMR were included.GCS was calculated from CMR cine images.The clinical endpoint was a composite of all-cause mortality,heart transplantation,implantable cardioverter defibrillator(ICD)implantation and aborted sudden cardiac death(SCD).A total of 129 patients with a mean EF of 15.33%(11.36%–22.27%)were included.During a median follow-up of 518 days,endpoint events occurred in 50 patients.Patients with GCS≥the median(−5.17%)had significantly reduced event-free survival as compared with those with GCS<the median(P<0.01).GCS was independently associated with adverse events after adjusting for clinical and imaging risk factors including extent of late gadolinium enhancement(LGE)(P<0.05).Adding GCS into the model including the extent of LGE resulted in significant improvements in the C-statistic(from 0.706 to 0.742;P<0.05)with a continuous net reclassification improvement(NRI)of 29.71%.It was concluded that GCS derived from CMR could be useful for risk stratification in DCM patients with severely reduced EF,which may increase common imaging risk factors including LGE.

HLA-DRB1 Gene Polymorphism in Patients with Dilated Cardiomyopathy

To probe into the genetic background and immunopathogenesis of dilated cardiomyopathy (DCM), HLA-DRB1 gene polymorphism in 68 patients with DCM and 175 normal control subjects were analyzed by using the polymerase chain reaction/sequence specific primer (PCR/SSP) techniques. It was found that the frequencies of HLA-DRB1 15 and HLA-DRB1 03 alleles were significantly lower in DCM patients than those in normal controls (14. 71 % vs 29. 71 % and 4. 41 % vs 15. 43 %, respectively), the relative risks (RR) in the DCM patients being 0. 41 and 0. 25, respectively, all P<0. 05. However, the frequencied of HLA-DRB1 11 and HLA-DRB1. 12 alleles were significantly higher in the DCM patients than in controls (29. 4 % vs 12. 00 % and 36. 76 % vs 12. 57 %, respectively) with the RR in the DCM patients being 3. 06 and 4. 04, respectively, all P<0. 01. These findings further demonstrated that-immunogenetics might play a predominant pathogenetic role in partial DCM patients.

Nemaline myopathy with dilated cardiomyopathy and severe heart failure: A case report

BACKGROUND Nemaline myopathy(NM)is a rare type of congenital myopathy,with an incidence of 1:50000.Patients with NM often exhibit hypomyotonia and varying degrees of muscle weakness.Skeletal muscles are always affected by this disease,while myocardial involvement is uncommon.However,with improvements in genetic testing technology,it has been found that NM with a mutation in the myopalladin(MYPN)gene not only causes slow,progressive muscle weakness but also results in dilated or hypertrophic cardiomyopathy.CASE SUMMARY A 3-year-old pre-school boy was admitted to our hospital with cough,edema,tachypnea,and an increased heart rate.The patient was clinically diagnosed with severe dilated cardiomyopathy and heart failure,and subsequent gene examination confirmed the diagnosis of NM with a mutation in MYPN.Captopril,diuretics,low-dose digoxin,and dobutamine were administered.After 22 d of hospitalization,the patient was discharged due to the improvement of clinical symptoms.During the follow-up period,the patient died of refractory heart failure.CONCLUSION Decreased muscular tone and dilated cardiomyopathy are common features of MYPN-mutated NM.Heart transplantation may be a solution to this type of cardiomyopathy.

Identification of a LMNA (c.646C>T) variant by whole-exome sequencing in combination with a dilated cardiomyopathy (DCM) related gene filter in a family with familiar DCM

Dilated cardiomyopathy（DCM）is characterized by the dilated heart chambers and reduced systolic function in the absence of specific aetiology[1].Approximately one third of DCM cases are hereditary.In recent years,DCM concomitant with arrhythmias and sudden death resulting from gene mutation has been widely

Clinical profile of patients with advanced age and inflammatoric dilated cardiomyopathy on endomyocardial biopsy

Background Endomyocardial biopsy （EMB） is an important tool when patients with inflammatoric cardiomyopathy （DCMi） are evaluated. We aimed to assess the clinical profile of elderly patients with DCMi on EMB. Methods Retrospective study of all consecutive patients hospitalized from January 2007 to December 2011 with clinical suspicion of DCMi undergoing EMB. Patients with evidence of DCMi on EMB （Group 1 〉 70 years, n = 85; Group 3 〈 70 years; n = 418） were compared to patients of the same age group without evi- dence of DCMi on EMB （Group 2 〉 70 years, n = 45; Group 4 〈 70 years; n = 147）. Results Among 24,275 patients treated at our institu- tion during the study period, 695 had clinical suspicion of DCMi and underwent EMB; 503 （2.1%） patients had DCMi on EMB. There were more male patients in Group 1, mean age was 74 ~ 2.8 years, mean ejection fraction was 38% q- 14%. On presentation, signs of hemody- namic compromise （NYHA functional class IIUIV, low cardiac output/index, and low cardiac power index） were more frequent in Group 1. EMB revealed viral genome in 78% of the patients, parvovirus B 19 （PVB） was frequently encountered in both age groups （Group 1： 69.4% vs. Group 2： 59.6%）; detection of more than one viral genome was more frequent in Group 1 （21.2% vs. 11.2%; P = 0.02） whereas the extent of immune response was significantly lower in individuals with advanced age. Conclusions In patients 〉 70 years with DCMi on EMB signs of hemodynamic compromise, detection of multiple viral genomes together with an overall lower extent of immune response were more frequently observed.

Rare combination of dilated cardiomyopathy and ankylosing spondylitis in a family

A 65-year-old man presented to our cardiovascular department due to fatigue and palpation on exertion during the previous three weeks. He had a medical history of diabetes mellitus and hyperlipemia without hypertension or myocarditis. However, he mentioned that his son had dilated cardiomyopathy （DCM） and ankylosing spondylitis （AS）. Examination at admission revealed a blood pressure of 115/69 mmHg and pulse of 82 beats/min. The results of routine blood tests for creatine kinase （CK）, CK muscle and brain （CK-MB）, troponin T, and thyroid function were all within normal limits. ECG revealed I, aVL, and V4--6 T wave inversion （Figure 1）. Ultrasonic cardiography showed that the left ventricular ejection fraction （EF） was 32%, in- dicating ventricular wall dysfunction. Angiography showed no coronary stenosis. Radionuclide imaging demonstrated myopathy of the anterior, part of the inferior, the posterior,and the lateral apical segments based on reduced radioactivity with a patchy pattern, consistent with DCM （Figure 2A）.

PRVALENCE OF ARRHYTHMIAS IN PATIENTS WITH IDIOPATHIC DILATED CARDIOMYOPATHY

A total of 105 patients with idiopathic dilated cardiomyopathy （IDCM） underwent Holter monitoring. The prevalence of arrhythmias was as follows: ventricular premature beats （VPB） 100%, including complex VPB 58.1%, short runs of ventricular tachycardia （VT） 25.7%, A-VB or BBB 46.7%, atrial arrhythmias 38.1%, sinus node dysfunction 6.6％, ST-T change 38.1%. The incidence of ventricular arrhythmia （VA） was not related to severity of cardiac dysfunction （NYHA）, duration of illness and sex. The most common arrhythmia was VA, the second one was heart block and atrial arrhythmia. Serum norepinephrine and epinephrine levels were 743.4± 252.5 and 688.0± 452.4 pg/ml, respectively, which were higher than those in control group （P<0.01）. Isoproterenol sensitivity test （ICD5） 8.43± 11.21 μg, was also much higher than that in control group （P<0.01）.Average H-V interval was 69.4±13.3 msec in HBE. Eight patients died.Two died of congestive heart failure （class Ⅱ-Ⅳ）,and six cases were diagnosed as sudden cardiac

Left Atrial Volume Index in Patients with Dilated Cardiomyopathy—Correlation with Left Ventricular Function

Background: The aim of this study was to determine the relation of left atrial (LA) volume and LA volume index with left ventricular function and to determine the association of duration of symptoms and left atrial volume index in patients with dilated cardiomyopathy. Materials and Methods: This was an observational, single centre study conducted in India. A total of 50 patients who were admitted to department of cardiology from July, 2008 to February, 2009 with diagnosis of dilated cardiomyopathy and an ejection fraction of <40% were included. Results: Of the 50 patients, 34 (68%) were males. 27 (54%) patients were in NYHA class II and 23 (46%) patients were in NYHA class III. LA volume was found to be ≥40 ml in all patients. LV function and LA volume were found to be correlated (r = -0.789, p < 0.01). Similarly, there was a correlation between LV function and LA volume index (r = -0.826, p < 0.01). There was no correlation between LA volume index and duration of symptoms (r = 0.04). Conclusion: It can be concluded that there is a strong inverse correlation between LA volume and left ventricular function and also between LA volume index and left ventricular function. The patients with NYHA class III were having larger left atrial volume than those with NYHA class II. Moreover, the duration of symptoms has no correlation with left atrial volume index.

Tissue Doppler,speckling tracking and four-dimensional echocardiographic assessment of right ventricular function in children with dilated cardiomyopathy

BACKGROUND Right ventricular(RV)function is frequently overlooked during dilated cardiomyopathy(DCM)evaluation.AIM To evaluate RV function in children with idiopathic DCM using relatively recent echocardiographic modalities.METHODS We prospectively studied the cardiac function in 50 children with idiopathic DCM and 50 healthy children as a control group,using four-dimensional echocardiography(4-DE),Tissue Doppler Imaging(TDI),and two-dimensional-speckles tracking echocardiography(2-D-STE).RV EF was measured by 4-DE.RESULTS The auto left(LV)ejection fractions(EF)measured by 2-D-STE were significantly lower in the patients'group than in the control.The sphericity index was also significantly lower in children with DCM than in the control.RV EF measured by 4-DE was significantly lower in the patient's group than the control.RV S wave,e´/a'ratio,myocardial performance index(MPI),and tricuspid annular plane systolic excursion(TAPSE)were significantly impaired in children with DCM than in control.Both LV and RV global longitudinal strains(GLS)were significantly reduced in children with DCM than in control.RVGLS was significantly associated with the duration since diagnosis,tricuspid annulus S wave,RV MPI,and TAPSE,but not with the age of the patients,RV EF,or e´/a'ratio.CONCLUSION There was impairment of the RV LGS and other systolic and diastolic parameters in children with DCM.STE and TDI can help to detect the early decline of RV function.