Segmental wall motion abnormalities in dilated cardiomyopathy: A common finding and good prognostic sign

Fifty patients with idiopathic dilated cardiomyopathy were separated into two groups based on the presence of segmental or diffuse left ventricular wall motion abnormalities by radionuclide ventriculography. Investigation included a history and physical examination, electrocardiogram, chest X-ray fi...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 1984-10, Vol.4 (4), p.674-679
Main Authors: Wallis, Diane E., O’Connell, John B., Henkin, Robert E., Costanzo-Nordin, Maria Rosa, Scanlon, Patrick J.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Biological and medical sciences
Bundle-Branch Block - diagnostic imaging
Bundle-Branch Block - physiopathology
Cardiology. Vascular system
Cardiomyopathy, Dilated - diagnostic imaging
Cardiomyopathy, Dilated - pathology
Cardiomyopathy, Dilated - physiopathology
Child
Echocardiography
Female
Heart
Heart - diagnostic imaging
Heart - physiopathology
Heart Failure - physiopathology
Humans
Male
Medical sciences
Middle Aged
Myocardial Contraction
Myocarditis. Cardiomyopathies
Myocardium - pathology
Pulmonary Wedge Pressure
Radionuclide Imaging
Stroke Volume
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Summary:Fifty patients with idiopathic dilated cardiomyopathy were separated into two groups based on the presence of segmental or diffuse left ventricular wall motion abnormalities by radionuclide ventriculography. Investigation included a history and physical examination, electrocardiogram, chest X-ray film, M-mode echocardiogram, coronary angiogram and right ventricular endomyocardial biopsy. Patients with histologic evidence of myocarditis were excluded. Sixty-four percent of the patients had segmental and 36% had diffuse wall motion abnormalities. The group with segmental abnormalities showed significant differences in age (52.5 ± 10.7 versus 37.8 ± 14.6 years, p < 0.001), New York Heart Association functional class HI to IV (56 versus 89%, p < 0.01), pulmonary capillary wedge pressure (14 ± 9 versus 26 ± 9 mm Hg, p < 0.001), left ventricular end-diastolic dimension measured on echocardiogram (67 ± 8 versus 77 ± 11 mm, p < 0.001), cardiac index (2.6 ± 0.6 versus 2.0 ± 0.5 liters/min per m2, p < 0.01) and ejection fraction by radionuclide ventriculography (20 ± 7 versus 13 ± 5%, p < 0.001). Patients with diffuse wall motion abnormalities had poorer histologic findings based on myocardial cell hypertrophy and nuclear changes (p < 0.01) and a higher short-term mortality with a 1 year survival rate of 50% compared with 90% in patients with segmental wall motion abnormalities by life-table analysis (p < 0.05). When data were reanalyzed excluding those patients with complete left bundle branch block, no significant change in any variable was detected. Segmental wall motion abnormalities, even when left bundle branch block is excluded, are common in dilated cardiomyopathy in the absence of coronary artery disease. Patients with segmental wall motion abnormalities have better global left ventricular function, less severe histologic abnormalities and a lower short-term mortality than those with diffuse wall motion abnormalities.
ISSN:0735-1097
1558-3597
DOI:10.1016/S0735-1097(84)80392-7