Hiroyuki Kayano

Predicting prognosis based on the shape of the left ventricular cavity in dilated cardiomyopathy: analysis using rate of improvement in the circle index.

PurposeTo elucidate the relation between a quantitative measure of the shape of the left ventricular cavity, cardiac function, and prognosis in patients with dilated cardiomyopathy (DCM).MethodsThe hearts of 20 healthy individuals and 18 patients with DCM were evaluated. Participants were aged 48.5 ± 5.0 years. On the basis of end-systolic four-chamber view echocardiograms, the endocardium of the left ventricle was traced and the resulting curve was segmented using 100 points. A line tangential to the curve was then drawn at each point, and the angle between two adjacent tangential lines was calculated. The deviation of these angles was designated as the circle index. The circle index and hemodynamic findings in patients with DCM were compared, and the rate of improvement in the circle index in these cases of DCM was determined. These patients were then placed into one of two groups: group R (11 patients), those with improvement rates of 10% or higher at time of discharge; and group NR (seven patients), those with rates less than 10%. Diuretic (furosemide) use, New York Heart Association (NYHA) classification, and readmission rate for the two groups were compared 2 years after discharge.ResultsThe circle index was 2.7 ± 0.9 in the DCM group and 17.5 ± 4.2 in the healthy group (P < 0.01). The circle index in the DCM group was correlated with pulmonary capillary wedge pressure (r2 = 0.42). Use of furosemide was unchanged in group R 2 years after discharge, but had increased for all patients in group NR. All cases in group R were classified as NYHA I 2 years after discharge. In group NR, in contrast, although all cases were classified as NYHA I at discharge, five of seven cases had deteriorated to NYHA III–IV 2 years later and were readmitted to hospital.ConclusionThere appears to be a quantifiable correlation between the circularity of the left ventricular cavity and the circle index. This suggests that rate of improvement after treatment for heart failure could predict prognosis in patients with DCM.

A case of hypertrophic obstructive cardiomyopathy in which left ventricular remodeling and reverse remodeling were seen with pacing on and off

A 77‐year‐old woman with hypertrophic obstructive cardiomyopathy was admitted to the hospital in March 2005 with a chief complaint of chest discomfort, and a left ventricular outflow tract (LVOT) gradient was seen. After starting apical dual chamber (DDD) pacing and oral cibenzoline 300 mg/day to relieve the stenosis, the pressure gradient and subjective symptoms disappeared. The patient was then followed as an outpatient. In January 2008, cibenzoline was discontinued because the patient experienced a hypoglycemic attack. Plain chest radiographs showed an increased cardiothoracic ratio from May 2009 and ventricular remodeling was suspected, although there were no changes in chest symptoms. Therefore, pacing off was considered. Acute changes in the LVOT gradient were evaluated with echocardiography before and after pacing on–off, but no changes were seen, so the course was observed in the pacing‐off state. The LVOT gradient gradually increased again from 7 months after pacing off, and the pressure gradient decreased again after pacing was restarted. On the electrocardiogram, a deep negative T wave was seen in V4–6 immediately after pacing off, but with time, it became positive, similar to before an implantable cardioverter defibrillator was inserted. Reverse remodeling was judged to occur after pacing off, and pacing therapy was restarted. The patient is currently under observation.