Patterns of Mechanical Inefficiency in XXXX and Their Relation to Left Ventricular Function and Clinical Outcomes.

@entity1 @entity384 @entity854 @entity204 @entity1002
BACKGROUND: @entity384 ( @entity384 ) is associated with @entity204 or transplantation and is typically considered a homogeneous process affecting global left ventricular (LV) function. However, assessment of regional abnormalities that contribute to pumping inefficiencies is lacking. The aim of this study was to define regional strain patterns of mechanical inefficiency in the broader context of LV discoordination (dysfunction and timing abnormalities) and to evaluate their associations with LV function and clinical outcomes. METHODS: Multiplanar apical LV echocardiographic images from @entity1 with pediatric @entity384 (n  =  56) and control subjects (n  =  20) were analyzed by two-dimensional longitudinal speckle-tracking strain analysis to identify segmental strain patterns and global contraction groups. Clinical outcome ( @entity204 or transplantation vs transplantation-free survival) and echocardiographic data were evaluated. Outcome groups were compared using the Fisher exact test, the   (2) test, or analysis of variance (with P values   <=  .05 considered to indicate statistical significance). RESULTS: Of 56 @entity1 with @entity384 , 29 (52%) progressed to @entity204 or transplantation. Five segmental strain patterns were observed that were used to define seven contraction groups by regional contractility and/or timing discoordination. The group(s) with the most discoordination had the most @entity1002 (P  =  .0004) and a trend toward the highest frequency of @entity204 or transplantation (P  =  .069). Interreader reproducibility of segmental strain patterns agreed in 165 or 180 (92%) segments tested (k  =  0.90). Control subjects had normal strain patterns. CONCLUSIONS: A heterogeneous @entity854 in the regional wall mechanics that lead to inefficient pump mechanics through functional and timing abnormalities were seen in this cohort and were categorized into natural subgroups. More severe LV discoordination was associated with increased @entity1002 and a trend toward @entity204 or transplantation.
