Strain and Strain Rate Measured on Echocardiogram 1-3 Weeks after Starting Treatment Is Worse in Acute Dilated Cardiomyopathy Pediatric Patients with Poor Outcomes at One Year

• Published in: Echocardiography (Mount Kisco, N.Y.) N.Y.), 2015-11, Vol.32 (11), p.1688-1696
• Main Authors: Webb, Melissa K., Auerbach, Scott R., Younoszai, Adel K., Patel, Sonali S., Landeck II, Bruce F.
• Format: Article
• Language: English
• Subjects: Acute Disease; Adolescent; Cardiomyopathy, Dilated - diagnostic imaging; Cardiomyopathy, Dilated - drug therapy; Cardiomyopathy, Dilated - physiopathology; Cardiotonic Agents - therapeutic use; Child; Child, Preschool; dilated cardiomyopathy; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Infant; Infant, Newborn; Male; Outcome Assessment (Health Care) - statistics & numerical data; Retrospective Studies; strain; strain rate imaging; Treatment Outcome; Ultrasonography; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - parasitology; Ventricular Dysfunction, Left - physiopathology
• ISSN: 0742-2822; 1540-8175
• DOI: 10.1111/echo.12947

Background Predicting later outcome around time of diagnosis of acute dilated cardiomyopathy (DCM) is difficult. We hypothesized that strain and strain rate on initial and follow‐up echoes were worse in patients with acute DCM from all causes with poor one‐year outcomes. Methods This was a retrospective study including all patients with DCM aged 0–18 years with left ventricle dilation, low ejection fraction, or low fractional shortening on initial echo. Longitudinal and circumferential strain and systolic and diastolic strain rate were measured on echo at presentation, 1–3 weeks after presentation, and at 1 year. Patients were separated into “Stable” (survivors) and “Progressive” (referred for transplant or died) outcome groups, and results were analyzed to determine whether strain or strain rate at each echo was worse in the “Stable” group compared with the “Progressive” group. Results The patient population included patients with DCM from idiopathic causes, myocarditis, iron deficiency anemia, lupus, chemotherapy, and LV noncompaction. Longitudinal and circumferential strain and systolic strain rate were significantly better in the “Stable” (n = 7) compared with the “Progressive” (n = 8) outcome group on 1‐ to 3‐week echo. Longitudinal strain more negative than −10% had 87% specificity and 100% sensitivity for predicting “stable” outcome (AUC 0.98), while circumferential strain more negative than −8% had 60% specificity and 100% sensitivity (AUC 0.83). Conclusions Longitudinal and circumferential strain and systolic strain rate measured 1–3 weeks after starting therapy are worse in acute dilated cardiomyopathy patients with poor one‐year outcomes. Further studies with less heterogeneity and more study subjects are needed.