Clin. Cardiol. 23, 813–819 (2000)
Kishore J. Harjai, M.D., F.A.C.C., Ravindra Edupuganti, M.D., Eduardo Nunez, M.D., Tansel Turgut, M.D., Luis Scott, M.D., Natesa G. Pandian, M.D., F.A.C.C.*
Department of Cardiology, Ochsner Clinic, New Orleans, Louisiana, and *Department of Medicine, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
Background: Left ventricular (LV) shape tends to become spherical in patients with dilated cardiomyopathy of diverse etiology. Clinical and echocardiographic factors which affect the degree of LV spherical distortion and the impact of altered LV shape on prognosis have not been studied adequately.
Hypothesis: This study was undertaken to investigate the prognostic implications of altered LV shape on clinical outcome in dilated cardiomyopathy.
Methods: In 112 patients with depressed LV ejection fraction (19 ± 9%) and symptomatic heart failure, and in 10 age- and gender-matched normal controls, we performed 2-dimensional echocardiography to assess LV shape using the eccentricity index. Eccentricity index was defined as the ratio of the LV long axis to the LV transverse diameter, measured at end systole and end diastole in the apical four-chamber view. We sought univariate and multivariate clinical and echocardiographic correlates of LV shape. Further, we sought correlations between eccentricity index and clinical outcomes (death and composite outcome of death or emergent heart transplant).
Results: Compared with controls, patients with cardiomyopathy had significantly lower systolic (2.04 vs. 1.56; p = 0.001) and diastolic (1.75 vs. 1.53; p = 0.003) eccentricity index, implying a more spherical LV shape. Of all clinical and echocardiographic variables tested, mitral regurgitation, right ventricular dysfunction, and increased LV mass were independently associated with spherical LV shape. At a follow-up period of 17 ± 12 months, no correlation was found between eccentricity index and the occurrence of death or the combined endpoint of death or emergent heart transplant, in univariate or multivariate analysis.
Conclusions: In patients with dilated cardiomyopathy, the degree of spherical distortion of the LV does not correlate with prognosis.
Key words: heart failure, prognosis, left ventricular shape
Address for reprints:
Kishore J. Harjai, M.D., F.A.C.C.
Ochsner Clinic at Lady of the Sea General Hospital
200 W 134th Place
Cut-Off, LA 70345, USA
Received: November 10, 1999
Accepted with revision: December 28, 1999