A biventricular stiffness index >14 assessed by 3D echocardiography independently predicted death or heart failure hospitalization in patients with non-ischemic DCM (HR 2.59; 95% CI 1.44-4.66; p=0.001).
Cohort (n=121)
Does biventricular stiffness assessed by 3D echocardiography predict death or heart failure hospitalization in patients with non-ischemic dilated cardiomyopathy?
Biventricular stiffness assessed with 3D echocardiography is an independent predictor of major cardiovascular events in patients with non-ischemic dilated cardiomyopathy.
Hazard Ratio: 2.59 (95% CI 1.44–4.66)
p-value: p=0.001
Abstract Background and purpose Dilated cardiomyopathy (DCM) determines remodelling of all cardiac chambers. Left ventricular (LV) stiffness reflects impaired relaxation and elevated filling pressures and it can be assessed non-invasively by 3D echocardiography. There are no studies regarding right ventricular (RV) stiffness or the role of ventricular stiffness in DCM. The scopes of our study were to evaluate LV stiffness index (LVSI), RV stiffness index (RVSI) and a novel biventricular stiffness index (BVSI) in a cohort of patients with DCM using 3D echocardiography, and to compare their prognostic role. Methods We prospectively enrolled 121 consecutive patients with non-ischemic DCM, who were followed for a composite endpoint of death or heart failure decompensation requiring hospitalisation. 3D echocardiographic acquisitions were performed using the multi-beat method; 3D LV and RV morphological and functional assessment were performed using dedicated software. LVSI was defined as 100 * the mitral E/ lateral annular e' ratio divided by 3D LV end-diastolic volume. RVSI was defined as 100 * the tricuspid Et/ lateral annular et' ratio divided by 3D RV end-diastolic volume. BVSI was defined as the sum of LVSI and RVSI. Results After 19±11 months, 55 patients reached the endpoint. There were no differences in 3D LV ejection fraction between patients with and without events (p=0.22). All three ventricular stiffness indices were significantly more impaired in patients with events (7.5±4.3 vs. 6±2.6, p=0.02 for LVSI; 5.1±3.3 vs. 4.1±1.9, p=0.047 for RVSI; 12.6±5.7 vs. 10.3±3.6, p=0.005 for BVSI) and they were all event predictors in univariable Cox regression (HR=1.11, p=0.003 for LVSI, HR=1.10, p=0.04 for RVSI, HR=1.10, p=0.001 for BVSI). LV ejection fraction did not predict outcome in regression analysis (p=0.08). We constructed a multivariable model using parameters with prognostic power in univariable Cox (age, NYHA class, mitral regurgitation severity and pulmonary artery systolic pressure) and tested ventricular stiffness in this model. All three stiffness indices were independent predictors when analysed as continuous variables (HR=1.10, p=0.01 for LVSI, HR=1.1, p=0.04 for RVSI, HR=1.1, p=0.003 for BVSI). However, only BVSI remained an independent predictor when analysed as a categorical variable (HR=2.59 95% CI, 1.44–4.66, p=0.001), while LVSI and RVSI did not (p=0.08 and p=0.14, respectively). A BVSI larger than 14 had 38% sensitivity and 86% specificity for event prediction. Conclusions Biventricular stiffness assessed with 3D echocardiography is an independent predictor of major cardiovascular events in DCM, a value over 14 being associated with a 2.6 fold risk of adverse outcome.
Vijiiac et al. (2026) conducted a cohort in Non-ischemic dilated cardiomyopathy (DCM) (n=121). Biventricular stiffness index (BVSI) > 14 vs. BVSI ≤ 14 was evaluated on Composite endpoint of death or heart failure decompensation requiring hospitalisation (HR 2.59, 95% CI 1.44-4.66, p=0.001). A biventricular stiffness index >14 assessed by 3D echocardiography independently predicted death or heart failure hospitalization in patients with non-ischemic DCM (HR 2.59; 95% CI 1.44-4.66; p=0.001).