Dyssynchrony In Patients Research Articles

Relation between electrical and mechanical dyssynchrony in patients with left bundle branch block: An electro- and vectorcardiographic study.

Current guidelines select patients for cardiac resynchronization therapy (CRT) mainly on electrocardiographic parameters like QRS duration and left bundle branch block (LBBB). However, among those LBBB patients, heterogeneity in mechanical dyssynchrony occurs and might be a reason for nonresponse to CRT. This study assesses the relation between electrocardiographic characteristics and presence of mechanical dyssynchrony among LBBB patients. The study included patients with true LBBB (including mid-QRS notching) on standard 12-lead electrocardiograms. Left bundle branch block-induced mechanical dyssynchrony was assessed by the presence of septal flash on two-dimensional echocardiography. Previously reported electro- and vectorcardiographic dyssynchrony markers were analyzed: global QRS duration (QRSDLBBB ), left ventricular activation time (QRSDLVAT ), time to intrinsicoid deflection (QRSDID ), and vectorcardiographic QRS areas in the 3D vector loop (QRSA3D ). The study enrolled 545 LBBB patients. Septal flash (SF) is present in 52% of patients presenting with true LBBB. Patients with SF are more frequent female, have less ischemic heart disease and smaller left ventricular dimensions. In multivariate analysis longer QRSDLBBB , QRSDLVAT and larger QRSA3D were independently associated with SF. Of all parameters, QRSA3D has the best accuracy to predict SF, although overall accuracy remains moderate (59% sensitivity, 58% specificity). The predictive value of QRSA3D remained constant in both sexes, irrespective of ischemic heart disease, ejection fraction and even when categorizing for QRSDLBBB . In LBBB patients, large QRS areas correlate better with mechanical dyssynchrony compared to wide QRSD intervals. However, the overall accuracy to predict mechanical dyssynchrony by electrocardiographic dyssynchrony markers, even when using complex vectorcardiographic parameters, remains low.

Cardiac Resynchronization Therapy in Heart Failure: Do Evidence-Based Guidelines Follow the Evidence?

Cardiac resynchronization therapy (CRT) for ventricular dyssynchrony in patients with heart failure has seen a steady increase worldwide; yet evidence of its effectiveness in certain subgroups is unclear. Given the high cost and risk of complications associated with these implants and their replacements, there is a need for clear clinical practice guidelines. In this report, we explore the variability of recommendations in published clinical practice guidelines and determine the extent of their evidential support. We conducted an electronic search for the most recent clinical practice guidelines and health technology assessments (HTAs) pertaining to a first implant of CRT in patients with heart failure and a systematic review of all published randomized controlled trials (RCTs) that evaluated the efficacy of CRT in heart failure patients with left ventricular dyssynchrony.1 We evaluated the concordance between recommendations on CRT use and evidence from the corresponding RCTs and meta-analyses of these RCTs. Because most recommendations were made within patient subgroups (such as New York Heart Association [NYHA] class, QRS morphology, and QRS interval), we determined how well represented these subgroups were in the major trials. We identified 4 clinical practice guidelines and 4 HTAs (Table I in the Data Supplement). Figure compares the guidelines for first-time use of CRT issued by the 4 professional societies and 2 of the HTAs. Two other HTAs were not included in Figure because they did not make recommendations by subgroups. Figure. Comparison of guidelines issued by the professional societies and health technology assessments (HTAs) for the use of cardiac resynchronization therapy (CRT) in heart failure. *For patients who have left ventricular ejection fraction ≤30%, †for patients who have left ventricular ejection fraction ≤35%, and ‡strong statistical and clinical evidence of benefit. ACCF/AHA indicates American College of Cardiology Foundation/American Heart Association; CCS, Canadian Cardiovascular Society; CRT-D, cardiac resynchronization therapy …

Mechanical dyssynchrony in patients with LBBB by 2D speckle tracking and real time 3D echocardiography

Mechanical dyssynchrony in patients with LBBB by 2D speckle tracking and real time 3D echocardiography

Permanent His bundle pacing to replace biventricular pacing for cardiac resynchronization therapy

IntroductionCardiac resynchronization therapy (CRT) or biventricular pacing (BIVP) has become a common procedure for the treatment of ventricular dyssynchrony in patients with heart failure, particularly in those with bundle branch block patterns (QRS durations >150ms) on the electrocardiogram (ECG). However, a large group of non-responders are made up of patients with dyssynchrony and QRS duration below 130ms. Recent studies have introduced permanent His bundle pacing as another method for achieving normalization of the QRS duration even in a majority of patients with right or left bundle branch block pattern on the ECG. HypothesesWe hypothesize 1. Biventricular pacing, (BIVP) performed as the standard procedure for CRT is inherently abnormal, spatially, at the right and left ventricular apex, and temporally, in regard to the timing of normal activation of the interventricular conduction system. Corollary 1. Permanent, selective, His bundle pacing (PHBP) is the most physiological form of ventricular pacing which replicates the normal activation of the interventricular conduction system. Corollary 2. An appropriately powered, prospective, crossover trial comparing PHBP with BIVP will show that the former is associated with the same benefits in patients with heart failure and QRS durations >130ms and would improve, rather than worsen, outcomes in heart failure patients with QRS duration <130ms. We present experimental and clinical evidence in support of these hypotheses.

The impact of left ventricular deformation and dyssynchrony on improvement of left ventricular ejection fraction following radiofrequency catheter ablation in Wolff-Parkinson-White syndrome: A comprehensive study by speckle tracking echocardiography.

The purpose of this study was to evaluate left ventricular (LV) deformation and LV dyssynchrony in patients with Wolff-Parkinson-White (WPW) syndrome and to identify the factors that affect the efficacy of radiofrequency catheter ablation (RFCA). Thirty patients (26 men, mean age 40±12years) with WPW syndrome were prospectively recruited for this study. They underwent 2-dimensional transthoracic echocardiography with speckle tracking analysis before RFCA and again within 48hours after RFCA. Control group consisted of 15 age and sex-matched healthy volunteers. The patients had significantly lower LV ejection fraction (LVEF), global longitudinal strain (Sl ), and global circumferential strain (Sc ) compared with healthy controls (64%±8% vs 68%±5%, P=.049; -17.6%±3.2% vs -19.9%±3.3%, P=.037, -15.2%±2.5% vs -19.4%±2.5%, P<.0001, respectively). Patients had a significantly higher dyssynchrony index relative to healthy controls (58.4±49.0ms vs 36.4±31.1ms, P=.031). After RFCA, there was a significant increase in LVEF and global Sc (68%±8% vs 64%±8%, P=.005; -17.3%±2.0% vs -15.2%±2.5%, P<.0001, respectively), along with a significant decrease in the dyssynchrony index (36.9±36.3ms vs 58.4±ms, P<.001) relative to the baseline values. Logistic regression revealed that the baseline dyssynchrony index was a predictor of LVEF improvement after RFCA (odds ratio: 1.060, P=.038). In WPW syndrome, impaired LV circumferential deformation can be restored by RFCA with concomitant improvement in LV dyssynchrony and LVEF.

A Study of Prevalence of Mechanical Dyssynchrony In Patients With Varying QRS Interval And Its Correlation With Left Ventricular Function Using Tissue Doppler Technique

A Study of Prevalence of Mechanical Dyssynchrony In Patients With Varying QRS Interval And Its Correlation With Left Ventricular Function Using Tissue Doppler Technique

Intraoperative assessment of transient and persistent regional left ventricular wall motion abnormalities in patients undergoing coronary revascularization surgery using real time three-dimensional transesophageal echocardiography: A prospective observational study.

To evaluate the feasibility of intraoperative real time three-dimensional echocardiography (RT3DE) for identification and quantification of transient and persistent regional wall motion abnormalities (RWMAs) in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting (CABG). A prospective observational study SETTING: Single-center study in an academic tertiary care hospital PARTICIPANTS: A series of 42 patients undergoing elective CABG over a 2-year period were included. After induction of anesthesia, a comprehensive transesophageal echocardiography (TEE) examination was performed to evaluate regional wall motion using two-dimensional wall motion score index (WMSI) and RT3D echocardiographic parameters at three specific time points during the operative phase. The 3D assessment of LV function was based on the quantification of change in LV chamber volume over time from each segment excursion. Patients were divided into two groups and subgroups based on TEE findings. There was significant mechanical dyssynchrony in patients with RWMAs (WMSI>1; systolic dyssynchrony index [SDI]=7.0±3.66) as compared to the patients having normal wall motion (WMSI=1; SDI=2.0±0.95; P=.001). Patients with contractile dysfunction were found to have low values of segmental excursion and high values of negative excursion on parametric imaging. Persistent RWMAs due to hibernating myocardium showed significant resolution of mechanical dyssynchrony after revascularization. Parametric imaging could detect transient RWMAs due to stunning and graft dysfunction. Early activating segments (EAS) on "timing bull's-eye" may represent hypercontractile segments and may influence inotrope administration. The RT3DE is a valuable modality for precise quantification of regional wall motion during revascularization procedure.

P5223The cure: demonstrating temporal resolution of mechanical dyssynchrony in patients with takotsubo syndrome using cardiovascular magnetic resonance myocardial feature-tracking

P5223The cure: demonstrating temporal resolution of mechanical dyssynchrony in patients with takotsubo syndrome using cardiovascular magnetic resonance myocardial feature-tracking

118 - The Prognostic Value of Diastolic and Systolic Mechanical Left Ventricular Dyssynchrony among Patients with Coronary Artery Disease and Heart Failure

Background: In patients with coronary artery disease (CAD) systolic and diastolic left ventricular mechanical dyssynchrony measured by gated single photon emission computed tomography (GSPECT) myocardial perfusion imaging (MPI) are associated with worse outcomes. Our aim was to examine the difference in prognostic effect of systolic and diastolic dyssynchrony in patients with CAD and heart failure (HF) or CAD alone. Methods: We included patients who presented to Duke University for GSPECT MPI with Myoview (GE Healthcare) between 1993 and 1999. Patients had CAD in at least one major coronary artery. We compared baseline characteristics and degree of mechanical dyssynchrony (Emory Toolbox) between CAD patients with HF and without. The distribution of dyssynchrony was compared to a control group without CAD. We performed Cox proportional hazard modeling with systolic and diastolic dyssynchrony variables for the all-cause mortality endpoint. Adjusted modeling included baseline characteristics, comorbidities, electrical dyssynchrony (QRS duration), as well as diastolic and systolic dyssynchrony parameters. Interactions between dyssynchrony variables and HF were examined in order to assess differences in the association of dyssynchrony and mortality between HF vs non-HF patients. Results: Of the 1294 patients 70% were male. HF was present in 25% of cases with a NYHA class II or III in 77% of these patients. Patients with HF had more comorbidities, higher end diastolic volumes [138 ml IQR (97–190) vs 111 ml IQR (88, 139)] and a lower ejection fraction [54% IQR (38–67) vs 63% (54–70)]. There were 537 deaths over a mean length of follow up of 6.7 years (IQR 4.9,9.3). The distribution of systolic and diastolic dyssynchrony parameters between patients with CAD + HF and CAD alone are displayed in the Fig. 1. Patients with CAD + HF had a lower survival than CAD alone at 6 years (56 %; 95% CI 50–61 vs 76%; 95% CI 73–79) and 10 years (33%; 95% CI 27–40 vs 59; 95% CI 55–62, P < .0001). HF was found to have no statistically significant interaction with dyssynchrony measures in the unadjusted and adjusted survival models. Conclusions: This is the first study to evaluate the prognostic value of systolic and diastolic mechanical dyssynchrony, as measured by GSPECT MPI, on mortality in patients with CAD + HF with mostly preserved ejection fraction. Patients with CAD + HF have a high prevalence of mechanical dyssynchrony and a higher mortality than CAD alone. However, the hazard for dyssynchrony was not different for HF vs non-HF patients. This relationship needs to be examined in patients with reduced ejection fraction.

P1563Relationships between electrical and mechanical dyssynchrony in patients with left bundle branch block

P1563Relationships between electrical and mechanical dyssynchrony in patients with left bundle branch block

Preliminary clinical study of left ventricular systolic dyssynchrony in patients with coronary heart disease by real-time three-dimensional echocardiography

Objective To figure out the preliminary clinical value of real-time three-dimensional echocardiography( RT-3DE) in evaluating the systolic dyssynchrony in patients with coronary artery heart disease(CAD). Methods Eighty patients who were suspected as CAD were included in this study. RT-3DE was performed first. After the analysis, we got the data: ejection fraction (EF), 16 segments systolic dyssynchronic index (SDI 16). All subjects should take the coronary angiography.According to coronary angiography results, the patients with the vascular stenosis rate ≥50% were defined as the CAD group, and the patients with the vascular stenosis rate <50% were defined as the coronary atherosclerosis group, the patients with the completely normal angiographic results were included in the control group according to the results of angiography. The parametric differences among the groups were compared. Results There was no significant difference in LVEF among the three groups. SDI 16 had no significant difference between the control group and the coronary atherosclerosis group (t=-1.03, P>0.05). However, SDI 16 had significant difference between the control group[(3.72±2.68)%]and the CAD group[(7.14±3.10)%], the same between coronary atherosclerosis group[(5.12±3.46)%] and the CAD group[(7.14±3.10)%](t=-3.71, -2.34, all P<0.05). ROC curve analysis revealed that a cut-off value for SDI of 5.49%, yielded a sensitivity of 81.8%, with a specificity of 73.1% to predict coronary atherosclerosis to CAD(AUC=0.743). Conclusion SDI 16 >5.49% has a higher value in evaluating systolic dyssynchrony in patients with CAD with RT-3D of Siemens Acuson SC2000 ultrasonic diagnostic instrument. Key words: Coronary artery disease; Echocardiography, stress

QRS Width as a Predictor of Right Ventricular Remodeling After Percutaneous Pulmonary Valve Implantation.

Recent data showed a right ventricular dyssynchrony in patients with tetralogy of Fallot (TOF). Percutaneous pulmonary valve implantation (PPVI) has become an important procedure to treat a pulmonary stenosis and/or regurgitation of the right ventricular outflow tract in these patients. Despite providing good results, there is still a considerable number of nonresponders to PPVI. The authors speculated that electrical dysfunction of the right ventricle plays an underestimated role in the outcome of patients after PPVI. This study aimed to investigate the influence of right ventricular electrical dysfunction, i.e., right bundle branch block (RBBB) on the RV remodeling after PPVI. The study included consecutive patients after correction of TOF with or without RBBB, who had received a PPVI previously at the Heart Center of the University of Leipzig, Germany during the period from 2012 to 2015. 24 patients were included. Patients without RBBB, i.e., with narrow QRS complexes pre-intervention, had significantly better RV function and had smaller right ventricular volumes. Patients with pre-interventionally QRS width below 150ms showed a post-interventional remodeling of the right ventricle with the decreasing RV volumes (p=0.001). The parameters of LV function and volume as well as RV ejection fraction remained unaffected by RBBB. The presented data indicate that the QRS width seems to be a valuable parameter in the prediction of right ventricular remodeling after PPVI, as it represents both electrical and mechanical functions of the right ventricle and may serve as an additional parameter for optimal timing of a PPVI.

P1554Electrical dyssynchrony in patients with left bundle branch block and factors related to its severity

P1554Electrical dyssynchrony in patients with left bundle branch block and factors related to its severity

Heart rate and dyssynchrony in patients with cardiac resynchronization therapy: a pilot study

Objectives: The objective of this pilot study was to describe the impact of paced heart rate on left ventricular (LV) mechanical dyssynchrony in synchronous compared to dyssynchronous pacing modes in patients with heart failure.Methods: Echocardiography was performed in 14 cardiac resynchronization therapy (CRT) patients at paced heart rates of 70 and 90 bpm in synchronous- (CRT), and dyssynchronous (atrial pacing + wide QRS activation) pacing modes. LV dyssynchrony was quantified using the 12-segment standard deviation model (Ts-SD) derived from Tissue Doppler Imaging. In addition, cardiac cycle intervals were assessed using cardiac state diagrams and stroke volume (SV) and filling pressure were estimated.Results: Ts-SD decreased significantly with CRT at 90 bpm (25 ± 12 ms) compared to 70 bpm (35 ± 15 ms, p = .01), but remained unchanged with atrial pacing at different paced heart rates (p = .96). The paced heart rate dependent reduction in Ts-SD was consistent when Ts-SD was indexed to average Ts and systolic time interval. Cardiac state diagram derived analysis of cardiac cycle intervals demonstrated a significant reduction of the pre-ejection interval and an increase in diastole with CRT compared to atrial pacing. SV was maintained at the higher paced heart rate with CRT pacing but decreased with atrial pacing.Discussion: Due to the small sample size in this pilot study general and firm conclusions are difficult to render. However, the data suggest that pacing at higher heart rates acutely reduces remaining LV dyssynchrony during CRT, but not during atrial pacing with dyssynchronous ventricular activation. These results need confirmation in a larger patient cohort.

Right ventricular dyssynchrony in pulmonary hypertension: Phase analysis using FDG-PET imaging

BackgroundRight ventricular (RV) performance in patients of pulmonary hypertension (PH) requires optimal assessment. The objective of this study is to develop phase analysis using 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging as a feasible tool for evaluation of RV dyssynchrony in PH. Methods and ResultsFifty-four PH patients with well-characterized hemodynamic parameters were enrolled. All subjects performed FDG-PET imaging for RV phase analysis and RV function evaluation. Two-dimensional echocardiography with speckle tracking analysis was conducted to obtain RV time to peak systolic strain (PSST) as a comparison. The median contraction delay difference between RV middle free wall and septum measured by PET phase analysis (RVPDPET) was 20.12° (interquartile range, 4.99°-30.10°). The median difference of PSST between RV middle free wall and middle septal wall (RVPDEcho) measured by echocardiography was 43.98° (interquartile range, 6.25°-72.00°). RVPDPET was well correlated with RVPDEcho (r = 0.685, P < .001). RV phase standard deviation (RVSD) and histogram bandwidth (RVBW) derived from PET phase histogram were significantly correlated with cardiac index, RV ejection fraction, 6-minute walking distance, and serum N-terminal pro B-type natriuretic peptide (NT-proBNP) (RVSD: r = −0.532, P < .001; r = −0.551, P < .001; r = −0.544, P < .001; r = 0.404, P < .01; respectively, RVBW: r = −0.492, P < .001; r = −0.466, P < .001; r = −0.544, P < .001; r = 0.349, P = .01, respectively), while there were no significant correlations between RVSD and RVBW with hemodynamic parameters (right atrial pressure, right ventricular systolic pressure, right ventricular end-diastolic pressure, mean pulmonary artery pressure, and total pulmonary resistance). ConclusionsContraction delays between RV free wall and septum in PH measured by phase analysis and speckle tracking echocardiography were well correlated. RV dyssynchrony measured by phase analysis of FDG-PET was significantly related to RV dysfunction. Phase analysis of FDG-PET is feasible to evaluate RV mechanical dyssynchrony in patients of PH.

Improvement in left ventricular intrinsic dyssynchrony with cardiac resynchronization therapy.

Objective:Cardiac resynchronization therapy (CRT) has been shown to induce a structural and electrical remodeling; the data on whether left ventricle (LV) reverse remodeling is associated with restitution of intrinsic contraction pattern are unknown. In this study, we investigated the presence of improvement in left ventricular intrinsic dyssynchrony in patients with CRT.Methods:A total of 45 CRT recipients were prospectively studied. Dyssynchrony indexes including interventricular mechanical delay (IVMD) and tissue Doppler velocity opposing-wall delay (OWD) as well as QRS duration on 12-lead surface electrocardiogram were recorded before CRT device implantation. After 1 year, patients with chronic biventricular pacing were reprogramed to VVI 40 to allow the resumption of native conduction and contraction pattern. After 4–6 h of intrinsic rhythm, QRS duration and all echocardiographic measurements were recorded. Dyssynchrony was defined as IVMD >40 ms and OWD >65 ms. CRT response was defined by a ≥15% reduction in left ventricular end-systolic volume (LVESV) at a 12-month follow-up.Results:Thirty-two patients (71%) showed response to CRT. The native QRS duration reduced significantly from 150±12 ms to 138±14 ms (p<0.001), and dyssynchrony indexes showed a significant improvement only in responders. The mean OWD reduced from 86±37 ms to 50±29 ms (p<0.001), and the mean IVMD decreased from 55±22 ms to 28±22 ms (p<0.001) in responders. The reduction in LVESV was significantly correlated with ΔOWD (r=0.47, p=0.001), ΔIVMD (r=0.45, p=0.001), and ΔQRS (r=0.34, p=0.022).Conclusion:Chronic CRT significantly improves LV native contraction pattern and causes reverse remodeling in dyssynchrony.

Risk Stratification of Future Left Ventricular Dysfunction for Patients with Indications for Right Ventricular Pacing due to Bradycardia.

Although right ventricular (RV) pacing is the only effective treatment for patients with symptomatic bradycardia, it creates left ventricular (LV) dyssynchrony, which can induce LV dysfunction and heart failure. The current criterion for consideration of cardiac resynchronization therapy (CRT) is LV ejection fraction (LVEF) ≤ 35%, but indication for CRT in patients required for RV pacing with LVEF > 35% remains unclear.We studied 40 patients, all LVEF ≥ 35%, who had undergone implantable cardioverter-defibrillator implantation with RV pacing < 5%. Echocardiography was performed at baseline and during RV pacing. LV dyssynchrony was defined as anteroseptal-to-posterior wall delay from the mid-LV short-axis view using two-dimensional speckle-tracking radial strain (significant: ≥ 130 ms). Patients were divided into two groups based on baseline LVEF: normal LVEF ( ≥ 50%; n = 20) and mildly reduced LVEF (35-50%; n = 20).LVEF and LV dyssynchrony in patients with mildly reduced LVEF deteriorated significantly during RV pacing compared to those in patients with normal LVEF. Moreover, changes in LV dyssynchrony during RV pacing significantly correlated with changes in LVEF (r = -0.44, P < 0.01). Multivariate logistic regression analysis showed that baseline LVEF was the only independent predictor and baseline LVEF < 48% predictive of significant LV dyssynchrony during RV pacing.The extent of RV pacing-induced LV dysfunction may be associated with baseline LV function. These adverse effects on patients with mildly reduced LVEF of 35-50% and indications for RV pacing due to bradycardia can thus be prevented by CRT.

Effect of Tidal Volume Size and Its Delivery Mode on Patient-Ventilator Dyssynchrony.

Although increasingly recommended, compliance with low Vt ventilation remains suboptimal. Dyssynchrony induced by low Vts may be a reason for it. To determine the effect of Vt size, and of the ventilator mode used for its delivery (volume vs. pressure control), on the magnitude of patient-ventilator dyssynchrony in patients with or at risk for acute respiratory distress syndrome. Nineteen mechanically ventilated patients underwent six consecutive ventilatory conditions: three on volume assist-control (VC) mode, each with set Vt of 6, 7.5, and 9 ml/kg, and three on adaptive pressure-control (APC) mode, with those same set Vts and matching inspiratory times. Triggering, cycling, and flow dyssynchronies were identified by inspection of airway flow and pressure tracings. A dyssynchrony index (DI) was calculated as the total number of dyssynchronies divided by the sum of ventilator cycles and ineffective triggering events, expressed as percentage. A severe DI was calculated including only double triggering and severe flow dyssynchronies. Under VC mode, the median (interquartile range) DIs were 100% (22-100%) at set Vt of 6 ml/kg, and 78% (7-100) at 7.5 ml/kg, both higher than 25% (0-45%) at 9 ml/kg (P = 0.02 and 0.01, respectively). Severe DI was higher at each reduction of Vt size. Under APC mode, compared with VC, DIs were lower at set Vt of 6 and 7.5 ml/kg (P = 0.004 for both). Changing from VC to APC resulted in an increase in exhaled Vt ≥ 1 ml/kg predicted body weight in a minority of patients. Lower Vts during VC ventilation result in higher patient-ventilator dyssynchrony in most patients with or at risk for acute respiratory distress syndrome. The use of APC mode is an option to reduce dyssynchrony, but it requires careful monitoring to avoid larger-than-target delivered volumes.

Acute effect of iloprost inhalation on right atrial function and ventricular dyssynchrony in patients with pulmonary artery hypertension

Right atrium function and ventricular function have significant prognostic value in pulmonary arterial hypertension patients. Acute changes in right ventricular synchrony and right atrium function postiloprost inhalation have not been evaluated. Cross-sectional study. Consecutive pulmonary arterial hypertension patients (group I from Nice classification) were included. Echocardiographic right atrium and right ventricular function pre- and postiloprost inhalation, including a right ventricular dyssynchrony index and right atrium function using speckle tracking, were performed in all patients. Twenty pulmonary arterial hypertension patients, 44±7years and 90% females, were included. After iloprost inhalation, we observed a significant increment in right ventricular fractional area change and a significant decrease in right ventricular dyssynchrony index (21.4±5.6% vs 26.1±4.0%, P=.007 and 79±44 vs 32±22mseconds, P<.01, respectively), also an improvement in right atrium reservoir function (8.6±3.1% vs 11.7±3.5%, P=.002). Iloprost inhalation induces acute changes in right ventricular function, dyssynchrony, and right atrium performance that may add relevant clinical information in the management and risk stratification of pulmonary arterial hypertension patients.

GW27-e1153 Echocardiographic Evaluation of Cardiac Dyssynchrony in Patients with Congestive Heart Failure

GW27-e1153 Echocardiographic Evaluation of Cardiac Dyssynchrony in Patients with Congestive Heart Failure