The Diagnostic Accuracy of Different Echocardiographic Predictors of Subtle Myocardial Dysfunction in Asymptomatic Duchenne Muscular Dystrophy Patients

Introduction: Duchennemuscular dystrophy (DMD) is an uncommon X-linked disease affecting in average 1 in 3600 live male births. Cardiac disease is the major cause of mortality in affected patients. Several Echocardiographic parameters are available for evaluation of systolic and diastolic function among Duchenne patients. The aim of this paper is to determine which of those parameters has the highest accuracy in detection subtle myocardial affection in asymptomatic Duchenne patients. Method:28 asymptomatic Duchenne patients as well as 28 age and sex matched healthy controls have been screened with Echocardiography including Motion mode, conventional and Tissue Doppler, 2 Dimensional (2D) and 3 Dimensional (3D) speckle tracking Echocardiography. Results: Conventional Echocardiographic parameters failed to differentiate cases from controls while Tissue Doppler derived parameter such as the ratio between Transmitral flow velocity in early diastole and Left Ventricular averaged basal septal and lateral tissue velocity (LV E/E’) as well as global longitudinal (GLS) and Global Circumferential strain (GCS) (2D and 3D) proved to be useful in differentiation between them. 3D derived ejection fraction also showed statistically significant difference between cases and controls (54.2±4.5 vs. 70.2±6.1, P Value<0.001) respectively, 3D derived parameters showed the highest sensitivities and specificities among relevant parameters (100%) for detection of subtle myocardial affection in Duchenne patients. Conclusion: This paper concludes that 3 D derived EF, GCS and GLS can be reliably used in detection of subtle myocardial affection in Duchenne patients.