319 Left ventricular restrictive filling pattern is associated with reduced cardiac sympathetic innervation in dilated cardiomyopathy

Aim: The assessment of new working classification based on clinical-echo data according to the site of the restriction to patients (pts) with RC confirmed by cardiac catheterisation (cath); the correlation with other noninvasive methods: radionuclide angiography (RA), computerized tomography (CT) and magnetic resonance imaging (MRI). Methods: We studied 19 pts wits RC, all confirmed by cath. A complete medical history and examination, electrocardiography, chest radiography and echo data (TM, 2D, Doppler) were performed in all pts. Echo data were compared with RA (11 pts), CT (8 pts), MRI (5 pts). Histopathological studies were performed with right ventricular endomyocardial biopsy samples in 7 pts; 5 pts underwent autopsy. Results: Three type of RC were identified based on noninvasive methods data according to the site of restriction: type A- symmetric RC (10pts), with biventricular restrictive Doppler pattern of flow, biventricular restrictive RA pattern (decreased filling fraction, increased time to peak filling rate >200ms, decreased peak filling rate, decreased first 1/3 diastolic filling fraction, atrial contribution to ventricular filling >30%) and biventricular restrictive morphology (normal dimensions of both ventricles, biatrial enlargement) on echo, CT, MRI data; type B- left asymmetric RC (5 pts) involves selectively the left ventricle and type C- right asymmetric (4 pts) affects only the right ventricle. Conclusions: The application of new working classification based on clinical-echo data according to the site of myocardial restriction may offer a coherent pathophysiological interpretation of various entities included in RC. Associated noninvasive methods can increase the accuracy of diagnosis by anatomic (CT, MRI) or functional (RA) data.