47cd01cc8ed71b58b701b9647fe035ac pmc_11242817.pdf fb8688fcc652a21ba48bc5821e7b029ca831c927 pmc_11242817.pdf cad31fdc2759a52bb6d78a3f15975f7861cd3c76c19c469b1a4b9ab0e5456edc pmc_11242817.pdf Title: Echocardiography-Derived Hemodynamic Forces Are Associated with Clinical Outcomes in Patients with Non-Ischemic Dilated Cardiomyopathy Subject: Introduction: Non-ischemic dilated cardiomyopathy (NIDCM) is characterized by a reduced left ventricular (LV) ejection fraction (LVEF, <50%) and a high risk for heart failure (HF) and death. Echocardiography-derived hemodynamic forces (HDFs) may provide important information on LV mechanics, but their prognostic value is unknown. Aim: To explore the features of echocardiography-derived HDFs in NIDCM and their association with clinical endpoints. Methods: Asymptomatic, non-hospitalized NIDCM patients free from coronary artery disease and moderate or severe valvular heart disease were included in this single-center observational retrospective longitudinal study. Those with atrial fibrillation and a follow-up <12 months were excluded. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death, HF hospitalization, and ambulatory intravenous diuretics administration. LV HDFs were analyzed with a prototype software. Apex-base (HDFs-ab), lateral-septal (HDFs-ls), and HDFs-angle were computed. Results: Ninety-seven patients were included, sixty-seven (69%) were males, mean age was 62 14 years, and mean LVEF was 39.2 8.6%. During a median follow-up of 4.2 (3.1–5.1) years, 19 (20%) patients experienced MACE. These patients had a higher HDFs-angle (71.0 (67.0–75.0) vs. 68.0 (63.0–71.0), p = 0.005), lower HDFs-ls (1.36 (1.01–1.85) vs. 1.66 ([1.28–2.04])%, p = 0.015), but similar HDFs-ab (5.02 (4.39–6.34) vs. 5.66 (4.53–6.78)%, p = 0.375) compared to those without MACE. in a Cox regression analysis, HDFs-angle (HR 1.16 (95%-CI 1.04–1.30), p = 0.007) was associated with MACE, while other conventional echocardiography parameters, including LVEF and LV longitudinal strain, were not. Conclusions: HDFs-angle is associated with clinical endpoints in NIDCM. A higher HDFs-angle may be a marker of impaired myocardial performance in patients with reduced LVEF. Keywords: hemodynamic forces; intraventricular pressure gradients; echocardiography; dilated cardiomyopathy; speckle tracking Author: Marco Cesareo, Eduard Ródenas-Alesina, Andrea Guala, Jordi Lozano-Torres, Guillem Casas, Fabrizio Vallelonga, Lorenzo Airale, Ignacio Ferreira-González, Alberto Milan and Jose F. Rodriguez-Palomares Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Sun Jun 30 12:54:38 2024 CEST ModDate: Sun Jun 30 13:01:05 2024 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 16 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1870041 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- ENXZUH+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 NFEZVG+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 ZHCJEZ+URWPalladioL-Roma Type 1 Custom yes yes yes 22 0 XJZSQT+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 FNEYCA+CMSY10 Type 1 Builtin yes yes yes 32 0 MEJHZL+VnURWPalladioL Type 1 Custom yes yes yes 37 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 53 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 56 0 LBIILL+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 76 0 LBIIML+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 82 0 LBIIMM+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 88 0 LBIINN+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 94 0 LBIINO+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 97 0 LBIINP+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 100 0 LBIJDO+PalatinoLinotype-Roman TrueType MacRoman yes yes no 103 0 LBIKPF+Calibri CID TrueType Identity-H yes yes yes 106 0 JLZORU+EURM10 Type 1 Builtin yes yes yes 119 0 QLBIEB+URWPalladioL-BoldItal Type 1 Custom yes yes yes 127 0 LBIILL+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 135 0 LBILFE+SymbolMT CID TrueType Identity-H yes yes yes 141 0 LBILGF+PalatinoLinotype-BoldItalic CID TrueType Identity-H yes yes yes 147 0 LBILGG+PalatinoLinotype-BoldItalic TrueType WinAnsi yes yes no 153 0 LBIIML+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 156 0 LBIIMM+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 162 0 LBIINN+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 168 0 LBIINO+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 171 0 LBIINP+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 174 0 LBIJDO+PalatinoLinotype-Roman TrueType MacRoman yes yes no 177 0 LBIILL+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 195 0 LBILGF+PalatinoLinotype-BoldItalic CID TrueType Identity-H yes yes yes 201 0 LBILGG+PalatinoLinotype-BoldItalic TrueType WinAnsi yes yes no 207 0 LBIONC+ArialMT CID TrueType Identity-H yes yes yes 210 0 LBIIML+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 216 0 LBIIMM+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 222 0 LBIINN+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 228 0 LBIINO+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 231 0 LBIINP+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 234 0 LBIJDO+PalatinoLinotype-Roman TrueType MacRoman yes yes no 237 0 LBIILL+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 271 0 LBIPPM+GillSansMT TrueType WinAnsi yes yes no 277 0 LBJAAO+GillSansMT-Bold TrueType WinAnsi yes yes no 280 0 LBJACA+GillSansMT-BoldItalic TrueType WinAnsi yes yes no 283 0 LBIIML+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 286 0 LBJACC+GillSansMT-Italic TrueType WinAnsi yes yes no 292 0 LBJADC+Cambria CID TrueType Identity-H yes yes no 295 0 LBIIMM+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 300 0 LBIINN+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 306 0 LBIINO+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 309 0 LBIINP+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 312 0 LBIJDO+PalatinoLinotype-Roman TrueType MacRoman yes yes no 315 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-02-06 02:50:00 CET RepresentationInformation: pmc_11242817.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-12-19 02:28:58 CET Size: 1870041 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 485 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Clinical Endpoint Destination: subsection.2.1 Item: Title: Echocardiography Destination: subsection.2.2 Item: Title: Deformation Imaging and Hemodynamic Forces Destination: subsection.2.3 Item: Title: Statistical Analysis Destination: subsection.2.4 Item: Title: Results Destination: section.3 Children: Item: Title: Correlation between Hemodynamic Forces and Clinical and Echocardiographic Variables Destination: subsection.3.1 Item: Title: Clinical Endpoints Destination: subsection.3.2 Item: Title: Discussion Destination: section.4 Item: Title: Limitations Destination: section.5 Item: Title: Conclusions Destination: section.6 Item: Title: References Destination: appendix.A. Info: Title: Echocardiography-Derived Hemodynamic Forces Are Associated with Clinical Outcomes in Patients with Non-Ischemic Dilated Cardiomyopathy Author: Marco Cesareo, Eduard Ródenas-Alesina, Andrea Guala, Jordi Lozano-Torres, Guillem Casas, Fabrizio Vallelonga, Lorenzo Airale, Ignacio Ferreira-González, Alberto Milan and Jose F. Rodriguez-Palomares Subject: Introduction: Non-ischemic dilated cardiomyopathy (NIDCM) is characterized by a reduced left ventricular (LV) ejection fraction (LVEF, <50%) and a high risk for heart failure (HF) and death. Echocardiography-derived hemodynamic forces (HDFs) may provide important information on LV mechanics, but their prognostic value is unknown. Aim: To explore the features of echocardiography-derived HDFs in NIDCM and their association with clinical endpoints. Methods: Asymptomatic, non-hospitalized NIDCM patients free from coronary artery disease and moderate or severe valvular heart disease were included in this single-center observational retrospective longitudinal study. Those with atrial fibrillation and a follow-up <12 months were excluded. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death, HF hospitalization, and ambulatory intravenous diuretics administration. LV HDFs were analyzed with a prototype software. Apex-base (HDFs-ab), lateral-septal (HDFs-ls), and HDFs-angle were computed. Results: Ninety-seven patients were included, sixty-seven (69%) were males, mean age was 62 14 years, and mean LVEF was 39.2 8.6%. During a median follow-up of 4.2 (3.1 5.1) years, 19 (20%) patients experienced MACE. These patients had a higher HDFs-angle (71.0 (67.0 75.0) vs. 68.0 (63.0 71.0), p = 0.005), lower HDFs-ls (1.36 (1.01 1.85) vs. 1.66 ([1.28 2.04])%, p = 0.015), but similar HDFs-ab (5.02 (4.39 6.34) vs. 5.66 (4.53 6.78)%, p = 0.375) compared to those without MACE. in a Cox regression analysis, HDFs-angle (HR 1.16 (95%-CI 1.04 1.30), p = 0.007) was associated with MACE, while other conventional echocardiography parameters, including LVEF and LV longitudinal strain, were not. Conclusions: HDFs-angle is associated with clinical endpoints in NIDCM. A higher HDFs-angle may be a marker of impaired myocardial performance in patients with reduced LVEF. 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