The Utility Of PW-DTI In Assessment For Early Therapeutic Effect After Anti-heart Failure Therapy In Dilated Cardiomyopathy

Objectives:By the use of conventional ultrasound cardiogram (UCG) as the control,the clinical application of pulsed-wave Doppler tissue imaging(PW-DTI) in the assessment of early therapeutic effects of anti-heart failure therapy in dilated cardiomyopathy(DCM) was evaluated.Methods:52 consecutive patients with congestive heart failure (CHF) caused by DCM were enrolled in this study,25 age- and sex-matched healthy subjects were recruited as the control.All DCM patients before and after 2-week anti-heart failure treatment were examined by UCG and PW-DTI.Early(Em) and late(Am) diastolic and systolic(Sm) mitral annulus velocities,and the Em/Am ratio were measured by PW-DTI.On the other hand,left ventricular diastolic diameter(LV),left atrial diastolic diameter(LA),LV ejection fraction (LVEF),early(E) and late(A) diastolic velocities of mitral inflow,and the E/A ratio were assessed by UCG.Results:As compared with the normal control,the patients with DCM exhibited significantly decreased LVEF,E/A,Sm,Em,Am,and Em/Am(p＜0.05,respectively),but significantly increased LA and LV(p＜0.001,respectively).Receiving 2-week anti-heart failure therapy,the DCM patients with improved cardiac function had significantly increased Em and Em/Am(p＜0.001,respectively).However,no significant difference of Em and the Em/Am ratio was found before and after therapy in the patients without cardiac function improvement. There were no significant difference of LVEF,E/A,LA,LV,E,A,Sm, Am before and after therapy in all the patient of DCM.Em,Em/Am showed a significant negative correlation with NYHA cardiac function.Conclusions:PW-DTI testing Em and the Em/Am ratio of mitral annulus is more sensitive than UCG to assess left ventricular diastolic function.These results suggest that the improvement of LV diastolic function is preceded to that of LV systolic function in DCM patients receiving anti-heart failure treatment.The improved of LV diastolic function is supposed to contribute to the clinical improvement of cardiac function after 2-week anti-heart failure in DCM patients.