ASSESSMENT OF VENTRICULAR-FUNCTION IN DILATED CARDIOMYOPATHIES

Regardless of its cause, systolic dysfunction in dilated cardiomyopath y triggers a wide variety of compensatory responses resulting in cardi ac dilatation, fluid retention, and systemic vasoconstriction. Standar d therapy with vasodilators, digoxin, and diuretics can provide sympto matic relief in many patients. However, many others do not respond ade quately and mortality from heart failure remains high. This has driven the search for novel therapies. To evaluate the efficacy and decipher mechanisms of action of these treatments, accurate assessments of lef t ventricular function are valuable. In particular, one seeks indexes that are cardiac-specific, in that they are minimally influenced by va scular loading conditions. An increasingly used ''gold standard'' that can achieve this goal is the invasively measured pressure-volume rela tion. Newer noninvasive methods have yielded several surrogates that h ave the key advantage of being applicable to chronic disease assessmen t. In this report, we review the current state-of-the-art in left vent ricular function assessment, and describe recent advances in its nonin vasive evaluation.