Abstract
This study sought to investigate, in patients with idiopathic-dilated cardiomyopathy,
the clinical and prognostic value of a Doppler-derived index of myocardial function
that combines systolic and diastolic time intervals of the left heart cycle. The Doppler
index was measured in 75 patients (aged 61 ± 13 years; 45 men and 30 women) in sinus
rhythm and 75 age- and sex-matched controls. Ejection time was measured from the left
ventricular outflow Doppler signal. The sum of isovolumic times was obtained by subtracting
the ejection time from the interval between cessation and onset of mitral inflow measured
from the mitral inflow velocity profile. The index was the sum of isovolumic times
divided by ejection time. The values of the Doppler index in patients with idiopathic-dilated
cardiomyopathy (0.85 ± 0.32) were significantly higher than values in controls (0.37
± 0.08, p < 0.001). During follow-up of 5 years, 1 patient underwent cardiac transplantation
and 36 patients died, 29 of cardiac, 5 of noncardiac, and 2 of unknown causes. Univariate
analysis demonstrated that the Doppler index (chi-square = 18.3, p < 0.001), ejection
fraction (chi-square = 15.2, p <0.001), symptom status (chi-square = 9.2, p = 0.002),
and mitral deceleration time (chi-square = 5.2, p = 0.02) were significant predictors
of outcome. However, multivariate stepwise analysis of these variables showed that
the Doppler index (chi-square = 10.7, p = 0.001) and ejection fraction (chi-square
= 6.7, p = 0.01) were the most significant independent predictors of outcome. The
Doppler index reflects disease severity and has incremental prognostic value in dilated
cardiomyopathy. Ease of use, nongeometric dependency, excellent separation of clinical
groups, and a strong relation to outcome enhance its appeal.
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Article info
Publication history
Accepted:
June 15,
1998
Received in revised form:
June 15,
1998
Received:
December 29,
1997
Identification
Copyright
© 1998 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
