الفهرس 
Idiopathic Dilated CardiomyopathyOnly 14 pages are availabe for public view
 |  | from | 160 |  |  |
| | | from | 160 | | |
Abstract
Cardiomyopathies are disorders of the cardiac muscle that cause mechanical and/or electrical dysfunction that result in dilated, hypertrophic or restrictive pathophysiology.
Dilated cardiomyopathy (DCM) is a non-ischaemic heart muscle disease with structural and functional myocardial abnormalities. The clinical picture of DCM is defined by left or biventricular dilatation and systolic dysfunction in the absence of coronary artery disease, hypertension, valvular disease or congenital heart.
The American Heart Association classifies DCM as genetic, mixed or acquired, whereas the European Society of Cardiology (ESC) groups cardiomyopathy into familial (that The WHO defines DCM as a serious cardiac disorder in which structural or functional abnormalities of the heart muscle can lead to substantial morbidity and mortality owing to complications such as heart failure and arrhythmia.
In 2010, the estimated mortality associated with cardiomyopathy was 5.9 per 100,000 global population, corresponding to " ~ "403,000 deaths — an increase from 5.4 per 100,000 in 1990 .These estimates may be affected by bias due to misclassification and missing or incomplete data, among others. In addition, there is a need for international consortia to group cohorts of patients so as to overcome the issue of the low number of events during follow-up.
Evaluation of contractile function with echocardiography has traditionally been limited to volume-based assessment of ejection fraction (EF) and assessment of regional wall motion or visual estimation of regional thickening. These methods have suffered from lack of reproducibility and standardization and are generally considered to be extremely sensitive to loading conditions. These limitations have led to an interest in techniques that provide more objective and reproducible measures of contractile function.
Myocardial deformation imaging is a novel echocardiographic method for assessment of global and regional myocardial function., allows for more direct assessment of myocardial muscle shortening and lengthening throughout the cardiac cycle by assessing regional myocardial strain and strain rate.
The aim of the study is to investigate the left ventricular deformations as a predictor of mortality in idiopathic dilated cardiomyopathy. Summary of our results: By comparing between both groups, IDCM patients were significantly older with much lower SBP as compared to control group (P<0.001, 0.018 respectively). In IDCM patients, HR ranged from 55 to 150 bpm with a mean of 89.8 ± 17.3 bpm which was significantly higher than that of control group (78.4 ± 12.3 b/m), P<0.002. Most patients (87.7%) had sinus rhythm, 7.5% had AF, and 4.8% had frequent PVCs In IDCM patients, QRS duration ranged from 50 to 200 ms with a mean of 104.7 ± 31.7 ms. LBBB was diagnosed in 24% of IDCM patients, RBBB in 1.9% and IVCD in 6.7% of patients and 43.2% showed voltage criteria in ECG. In IDCM patients, LA diameter (P<0.001), LA volume (P<0.001), LA volume index (P<0.001), ESD (P<0.001), EDD (P<0.001), LVM (P<0.001), E/e’ ( P=0.024), Mitral E/A (P<0.001), RV Basal diameter (P=0.008), RV Longitudinal diameter (P<0.001), RV Thickness (P<0.001), RV EDV (P<0.001) and RV ESV (P<0.001) ,
were significantly higher in comparison to control group. On the other hand, FS (P<0.001), EF (P<0.001), E’ (P<0.001), S’(P<0.001), e’ of mitral anulus (P<0.001) and RV EF (P<0.001) were significantly lower in IDCM patients compared with control group In IDCM patients 31.1% showed trivial TR, 42.5% had mild TR, 14.2% had moderate TR and 9.4% had severe TR. In terms of MR severity, 12.3% of IDCM patients experienced trivial MR, 35.8% had mild MR, 29.2% had moderate MR and 22.6% had severe MR. In IDCM group LV GLS and LV SRsys & SRe were markedly reduced in comparison to control group (-5.7 ± 4.1 vs -19.9 ± 2.5, P<0.001), (-0.5 ± 0.5 and -1.3 ± 0.2, P<0.001), and (0.4 ± 0.3 vs 1.6 ± 0.3, P<0.001) respectively. While LV mechanical dyysynchrony as expressed by TTP-SD (84.9 ± 61.3 vs 29.2 ± 16.8, P<0.001), and LV filling pressure as reflected by E/e’ (12.6 ± 17.2 vs 44.8 ± 0.6, P=0.024) were significantly higher in comparison to healthy individuals. In IDCM group longitudinal εsys% of RVFW (P<0.001), septum (P<0.001) and RV GLS (P<0.001) were significantly lower in comparison to control group. RV strain rate during systole (SRsys) and early diastole (SRe) were significantly lower in IDCM patients (P<0/001) respectively. Furthermore, RV mechanical dyssynchrony as represented by TTP-d (P<0.001) and RV TTP SD (P<0.001) were significantly increased compared with healthy individuals. There was no significant difference in IDCM survivors and non- survivor In clinical and demographic data.