The Value of Hemodynamic Force Evaluation in Predicting Left Ventricular Reverse Remodeling in Idiopathic Dilated Cardiomyopathy

The dynamic changes in left ventricular diastolic function in dilated cardiomyopathy (DCM) patients after guideline-directed medical therapy (GDMT) are not yet well understood. Hemodynamic force (HDF) analysis is a new cardiac magnetic resonance (CMR) post-processing technique that can separately measure systolic and diastolic function. This study aims to evaluate the temporal evolution of systolic and diastolic function using HDF and its association with left ventricular reverse remodeling (LVRR) in DCM patients.

Methods:

We analyzed a prospectively enrolled observational cohort of DCM patients who received GDMT and underwent baseline and follow-up CMR examinations between February 2016 and May 2020. We assessed HDF parameters, including longitudinal force, systolic peak, systolic ejection force, diastolic suction force, E-wave deceleration, A-wave acceleration force, and late diastolic deceleration force. Statistical analyses were performed using Student's t-tests, logistic regression, and linear regression.

Results:

Among 151 DCM patients, 49 (32.5%) experienced LVRR, with a median follow-up period of 14.0 (12.0-18.0) months. There were no significant differences in diastolic HDF parameters at baseline between patients with and without LVRR. However, at follow-up, patients with LVRR exhibited better diastolic HDF parameters compared to those without LVRR, including diastolic suction force [-4.2 (-5.8, -2.5) vs. -2.9 (-5.0, -1.1), P=0.009], E-wave deceleration force [7.5 (5.2, 11.3) vs. 5.7 (3.4, 8.2), P=0.008], A-wave acceleration force [-1.8 (-2.8, -0.6) vs. -1.0 (-1.8, -0.4), P=0.045], and late diastolic deceleration force [7.1 (4.3, 9.7) vs. 4.7 (2.7, 6.6), P=0.003]. Stepwise multivariate logistic regression analyses revealed that better baseline diastolic suction force [Odds Ratio (OR): 0.87 (0.76-0.98), P=0.025] independently predicted LVRR after adjusting for new-onset heart failure (HF) and left ventricular ejection fraction (LVEF).

Conclusion:

After at least 12 months of GDMT, 32.5% of patients experienced LVRR, accompanied by longitudinal HDF improvement. Better baseline diastolic suction HDF independently predicted LVRR in DCM patients.