Prognostic value of different left ventricular filling patterns assessed by automated border detection technique in patients with dilated cardiomyopathy

Patients with dilated cardiomyopathy (DCM) often require invasive evaluation of left ventricular diastolic function. Using automated border detection (ABD) technique we calculated left ventricular diastolic parameters such as peak filling rate (PFR), peak atrial filling rate (PAFR), both normalized for end-diastolic volume, PFR/PAFR ratio, and time to PFR. We also compared derivative ABD indexes with transmitral Doppler flow parameters (peak of E wave, peak of A wave and E/A ratio) in patients with different degrees of diastolic dysfunction. Furthermore, we studied 30 ambulatory DCM patients (21 males, 9 females, mean age 62 ± 9 years, ejection fraction 27 ± 11%), all in sinus rhythm, and 12 age-matched normal subjects using ABD technique. DCM patients did not differ from normal subjects by E/A (2 ± 2.6 vs 0.98 ± 0.3) and PFR/PAFR ratios (2.0 ± 1.4 vs 1.3 ± 0.3). A significant correlation was found between E/A and PFR/PAFR ratios (r = 0.81, p < 0.001). Subdividing DCM patients according to transmitral filling patterns (abnormal relaxation, pseudonormalized, and restrictive) we found in DCM patients with severe diastolic dysfunction a significantly decreased PAFR and time to PFR with an increased PFR/PAFR ratio. In conclusion, a) ABD-derived parameters of left ventricular function provide a simple and reliable method for the evaluation of diastolic dysfunction in DCM patients; b) PFR/PAFR ratio is able to differentiate DCM patients with pseudonormalized left ventricular filling pattern; c) this method may be used in different clinical conditions for serial evaluation of left ventricular performance.