Left Ventricular Dyssynchrony In Patients Research Articles

Association between an early revascularization strategy and major cardiac events based on left ventricular dyssynchrony in patients at intermediate risk of major cardiac events using the J-ACCESS risk model.

Objective This retrospective study aimed to investigate the association between therapeutic strategies and the development of major cardiac events (MCEs) in intermediate-risk patients by using the J-ACCESS risk model in combination with the stress phase bandwidth (SPBW), an index of left ventricular dyssynchrony. Methods Patients were followed-up for three years to confirm their prognosis. Based on the estimated propensity scores, the patients who underwent revascularization within the first 60 days after SPECT and those who did not were matched 1:1 (n = 367 per group). The composite endpoint was the occurrence of MCEs, consisting of cardiac death, non-fatal myocardial infarction, and severe heart failure. SPBW was calculated by a phase analysis using the Heart Risk View-F software program, and the MCE rate was compared between the two groups by applying the normal value of SPBW (38°). Patients The study included 2,053 patients with either known or suspected CAD who underwent electrocardiogram-gated single-photon emission computed tomography myocardial perfusion imaging and were at intermediate risk of MCE according to the J-ACCESS risk model. Results During follow-up, 54 of the 734 patients (7.4%) experienced MCEs. The overall incidence of MCE in intermediate-risk patients was not significantly different between the two groups. However, the incidence of MCE in patients with an abnormal SPBW was significantly lower in those who underwent early revascularization (4.8% vs. 11.9%, P = 0.0407). Conclusion The combination of the J-ACCESS risk model and the SPBW is thus considered to be an optimal treatment strategy for patients at intermediate risk of MCE, and early revascularization may lead to an improved prognosis in intermediate-risk patients with an abnormal SPBW.

The evaluation of left ventricular dyssynchrony in hypertensive patients with a preserved systolic function undergoing gated SPECT myocardial perfusion imaging.

Hypertension as a known risk factor for cardiovascular diseases can result in left ventricular dyssynchrony (LVD) leading to uncoordinated contraction. The aim of our study was to evaluate whether systolic mechanical dyssynchrony measured by phase analysis of gated single-photon emission computed tomography (SPECT) imaging occurs in hypertensive patients with a low risk for coronary artery disease and a normal ejection fraction and its possible relationships with severity of hypertension and the influence of antihypertensive treatments. A total of 466 patients (328 females and 138 males, with a mean age of 59.62 ± 10.27years) who had a low risk factor for coronary artery disease, a normal perfusion study and, a normal ejection fraction were included of which 408 was hypertensive and 58 normotensive. Phase analysis parameters (derived using QGS software) were compared in patients with and without hypertension. Using different statistical methods, relationship between derived phase analysis indices (PSD, PHB) for LVD and amount of blood pressure and antihypertensive drugs consumption were evaluated. The prevalence of LVD in patients with hypertension was 63.2% (n = 258), while it was 6.9% in the normotensive group. The mean values of PSD and PHB were higher in hypertensive patients than normotensive ones (12.55 vs. 5.8 and 39.24 vs. 21.12), respectively, so that, statistically significant differences were found between the patients with and without hypertension (p < 0.001). Furthermore, there was a clear relationship between the severity of hypertension and the degree of LVD: by increasing 1mmHg in systolic and diastolic blood pressure, PSD and PHB increase by (0.034, 0.108 and 0.035,0.0311), respectively. The statistical results showed that the frequency of LVD in controlled hypertensive patients taking antihypertensive drugs was 55.2%, which significantly lower compared to the patient suffering from hypertension without taking any hypertensive drug (81.35%, p < 0.001). Our study findings are in favor of using phase analysis-gated SPECT imaging as a routine way for detection of LVD-known indicator of progression toward systolic dysfunction in the future-in hypertensive patients with a low risk for coronary artery diseases and a normal cardiac systolic function.

T-wave Amplitude in aVR for Left Ventricular Dyssynchrony in Patients with Complete Left Bundle Branch Block

T-wave Amplitude in aVR for Left Ventricular Dyssynchrony in Patients with Complete Left Bundle Branch Block

T-wave Amplitude in aVR for Left Ventricular Dyssynchrony in Patients with Complete Left Bundle Branch Block

<dm:abstracts xmlns:dm="http://www.elsevier.com/xml/dm/dtd"><ce:abstract xmlns:ce="http://www.elsevier.com/xml/common/dtd" id="ab0005" xml:lang="en" view="all" class="author"><ce:section-title id="st0005">Abstract</ce:section-title><ce:abstract-sec id="as0005" view="all"><ce:simple-para id="sp0055" view="all">With advancing age, the conduction system and heart muscle cells undergo degenerative alterations affecting the electrocardiographic (ECG) parameters. The goal of the study is to determine the effect of age on ECG parameters. Are these changes due to a ‘normal aging’ or are they indicative to a ‘heart disease’?</ce:simple-para><ce:simple-para id="sp0060" view="all">Italian Longitudinal Study on Aging (ILSA) database has been created to evaluate physiologic and pathologic modifications connected with aging. Standard 12-leads ECG recordings (10 s, 500 Hz) have been taken twice in a period of three years. The database consists of 890 individuals aged 65–84 years.</ce:simple-para><ce:simple-para id="sp0065" view="all">Analysis of changes has been done also in two groups of individuals in ILSA database – with and without cardiovascular abnormality. This analysis showed a nearly equal age-related change in both groups.</ce:simple-para><ce:simple-para id="sp0070" view="all">The main changes are reduction in the amplitudes of QRS- and T-waves, referred as ‘ECG attenuation phenomenon’. QRS<ce:inf loc="post">t1</ce:inf> = 0.85 mV at the time of the first recording t1, and QRS<ce:inf loc="post">t2</ce:inf> = 0.81 mV at the time of the second recording t2, the period between the two recordings being three years (p &lt; 0.0001). Respectively T<ce:inf loc="post">t1</ce:inf> = 0.11 mV, T<ce:inf loc="post">t2</ce:inf> = 0.10 mV, p = 0.0013.</ce:simple-para><ce:simple-para id="sp0075" view="all">ECG attenuation phenomenon is more common in males, and it is not significant in females. This attenuation is manifested significantly also in healthy male group, suggesting geriatric changes of “normal aging”. Nevertheless, some cardiovascular diseases, such as arrhythmias and hypertension, may have a strong influence on the QRS attenuation, and this supports the open question of the clinical relevance of the phenomenon.</ce:simple-para><ce:simple-para id="sp0080" view="all">ECG attenuation phenomenon is more manifested in younger individuals and occurs independently of body mass.</ce:simple-para><ce:simple-para id="sp0085" view="all">ECG attenuation phenomenon is a significant fact, and therefore it should be considered in any serial ECG study, for example in the ECG analysis for human identification.</ce:simple-para></ce:abstract-sec></ce:abstract></dm:abstracts>

Effects of bone marrow mononuclear cells delivered through a graft vessel in patients with previous myocardial infarction and chronic heart failure: An echocardiographic study of left ventricular dyssynchrony.

Several trials are investigating the delivery of stem cells to treat ischemic cardiomyopathy. The aim of this study was the echocardiographic evaluation of the effectiveness of isolated coronary artery bypass graft (CABG) combined with bone marrow mononuclear cells (BMMNC) delivered through the graft vessels to improve left ventricular dyssynchrony in patients with previous myocardial infarction and chronic heart failure. 42 patients with previous myocardial infarction and chronic heart failure were randomly allocated to either the CABG only group (n = 18) or the CABG with BMMNC graft group (n = 24group). We used 2D strain imaging to measure the absolute difference in time-to-peak radial strain between the earliest and the latest activated segments on LV short-axis images at the apical (RSTa), at the mitral annulus (RSTb), and at the papillary muscle (RSTm) level. The effective rate of LV dyssynchrony improvement was significantly higher in the CABG + BMMNC than in the CABG only group (RSTb: 91.7% vs 50%, P < .05; RSTm: 78.6% vs 35.7%, P < .05; RSTa: 92.3% vs 50%, P < .05). The deterioration rate of LV synchrony was significantly lower in the CABG + BMMNC than in the CABG only group for RSTb (8.3% vs 70%, P < .05;) and RSTm (0 vs 50%, P < .05), but not for RSTa (18.2% vs 37.5%, P > .05). Combining CABG with BMMNC delivering provided a better improvement of left ventricular dyssynchrony than CABG only.

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.

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.

Prevalence and predictors of left intraventricular dyssynchrony determined by phase analysis in patients undergoing gatedSPECT myocardial perfusion imaging.

Left ventricular dyssynchrony (LVD) is an independent predictor of adverse cardiovascular events, death, and progression to heart failure. Myocardial perfusion imaging (MPI) with ECG-gated single-photon emission computed tomography (SPECT) can be used to diagnose LVD rapidly and automatically using phase analysis (PA). The objective of this study was to evaluate the prevalence and predictors of LVD in patients undergoing MPI. Clinical, electrocardiographic, and scintigraphic data from 1000 patients who underwent MPI with ECG-gated SPECT over a period of 1year were analyzed retrospectively. TheEmoryCardiac Toolboxsoftware was used for PA, and LVD was diagnosed based on the following criteria: standard deviation of LV phase distribution ≥43° and/or phase histogram ≥140° in the resting and/or stress phase of the examination. Several variables were evaluated using univariate and multivariate analyses. The prevalence of LVD in the study population was 6.5%, and the average age was 63.6±12years. The variables significantly associated with LVD were male gender, obesity, hypertension, diabetes, dyslipidemia, coronary artery disease (CAD), QRS interval ≥120ms, LV dysfunction, and myocardial perfusion defects (especially fixed defects) on MPI. Although the PA parameters were greater at rest, both phases could be used for diagnosis. Multivariate analysis revealed that the variables significantly associated with LVD were male sex, obesity, history of CAD, and QRS interval ≥120ms. The overall prevalence of LVD was 6.5% in patients undergoing MPI in this study, and it reached 42% in the presence of certain risk factors.

Abstract 13940: Risk Stratification of Future Left Ventricular Dysfunction in Patients With Indications for Right Ventricular Pacing Owing to Bradycardia

Background: Although right ventricular (RV) pacing is the only effective treatment for patients with symptomatic atrioventricular block, it creates left ventricular (LV) mechanical dyssynchrony, which can induce LV dysfunction and heart failure. 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 &gt;35% remains uncertain. Methods: We studied 35 consecutive patients with LVEF of 51±9% (all≥35%) who had undergone implantable cardioverter-defibrillator implantation (RV pacing &lt;5%). Echocardiography was performed at baseline and during RV pacing. LV dyssynchrony was determined by the anteroseptal-to-posterior wall delay from mid-LV short-axis view using two-dimensional speckle-tracking radial strain (≥130ms as significant). Patients were divided into two groups based on baseline LVEF: preserved LVEF≥50% (n=19) and mildly reduced LVEF of 35-50% (n=16). Results: LV dyssynchrony in patients with mildly reduced LVEF was significantly worsened during RV pacing compared to that in patients with preserved LVEF (from 86.0±103.9ms to 214.6±132.1ms vs. from 21.7±29.0ms to 65.6±90.9ms, p=0.01). Furthermore, the prevalence of significant LV dyssynchrony during RV pacing in patients with mildly reduced LVEF was significantly higher than that in patients with preserved LVEF (68% vs. 16%, p&lt;0.01). LVEF in patients with mildly reduced LVEF was also significantly worsened during RV pacing compared to that in patients with preserved LVEF (from 42.8±4.6% to 37.6±6.8% vs. from 58.3±5.7% to 57.9±6.9%, p&lt;0.01). Conclusions: The amount of RV pacing-induced LV dysfunction may be associated with baseline LV function. Thus, these adverse effects in patients with mildly reduced LVEF of 35-50% and indications for RV pacing owing to bradycardia can be prevented by CRT.

Effect of activating intrinsic conduction search on left ventricular dyssynchrony in patients with conventional pacemaker

Rightventricular(RV)apicalpacingcreatesanabnormalventricularactivation pattern inducing cardiac dyssynchrony, ventricular dysfunc-tion,andanincreasedmortalityrisk[1–3].Atrial-basedpacingtomain-tainatrioventricular(AV)synchronycandecreasetheincidenceofatrialfibrillation (AF), heart failure and overall mortality rates [1]. However,evenwhenAV-nodefunctionispreserved,dual-chamber(DDD)pacingoften results in frequent ventricular pacing [3]. Previous analyses linkthefrequencyofRVpacedbeatstoincreasedrisksofAFandheartfailurein patients with sinus-node disease [4].To overcome the limitations of pacing-induced asynchronouselectricalactivation,devicealgorithmshavebeendevelopedtopromotenormal AV synchrony by preserving the physiologic ventricular activa-tion sequence [2].Specifically, intrinsic conduction search (ICS) hasbeen shown to lead to a decrease in unnecessary RV pacing and itsadverse consequences on left ventricular function [5,6].Moreover,pulsegeneratorlongevityisanimportant issueinthecareof pacemaker patients [7]. One of the determinants of pacemaker lon-gevityisthe energy consumption ofthepulsegenerator,whichdependson programmable variables, including output parameters of the system(voltage and pulse width), and the frequency and percentage of pacing.A previous study using an algorithm to preserve normal AV synchrony

Prognostic significance of NT-proBNP, 3D LA volume and LV dyssynchrony in patients with acute STEMI undergoing primary percutaneous intervention

ObjectivesThe aim of the present study was to assess the short term prognostic significance of N-terminal pro BNP (NT-proBNP), 3D left atrial volume (LAV) and left ventricular (LV) dyssynchrony in patients of acute ST-elevation myocardial infarction (STEMI) who underwent primary Percutaneous intervention (PCI). BackgroundNT-proBNP, LV dyssynchrony and LAV in patients with acute coronary syndrome have been associated with PCI outcomes and predict the short and long-term prognosis. MethodsThis study consisted of 142 patients with a first STEMI who underwent primary PCI. Baseline echocardiographic data was collected at admission and at 6 months follow up. Left ventricular dyssynchrony was measured by tissue Doppler imaging and LAV by real time 3D-echocardiography, plasma NT-proBNP levels were estimated between 72 and 96 h of admission. ResultsDuring study period 3 patients expired and 4 developed congestive heart failure (CHF). Baseline NT-proBNP and LV dyssynchrony correlated with LV size and LV ejection fraction (LVEF) at baseline and during follow up. Patients with higher NT-proBNP levels and higher LV dyssynchrony showed significant increase in LV size with decrease in LVEF during follow-up. Baseline Left atrial volume index (LAVI) showed significant correlation with LV size but no association with LVEF at baseline and during follow-up. ConclusionsHigher levels of NT-proBNP and higher LV dyssynchrony can predict patients with increase in LV size, worsening of LV systolic and diastolic function during follow-up. Patients with higher NT-proBNP levels at baseline developed CHF during follow-up.

Prevalence of Left Ventricular Dyssynchrony in Patients with Congenital Atrioventricular Block and Long-Term Pacing: A Three-Dimensional Echocardiographic Study.

Left ventricular (LV) dysfunction is the major reason for poor outcomes in patients with congenital complete atrioventricular block (CCAVB) and pacemaker. Long-term pacing has been associated with LV mechanical dyssynchrony. However, the relationship of dyssynchrony and LV dysfunction is not clear. We sought to evaluate the prevalence of LV dyssynchrony by real time three-dimensional echocardiography (RT3DE) in patients with CCAVB and its association with LV dysfunction. In addition, we evaluated the agreement between RT3DE and tissue Doppler imaging (TDI) for detecting LV dyssynchrony. We studied 50 patients [median age 20 years old (5 months to 62 years), 68% women] with CCAVB and pacemaker who underwent complete two-dimensional echocardiography and RT3DE. LV dyssynchrony was considered if the systolic dyssynchrony index (SDI) was ≥ 5%. Intraventricular mechanical delay was defined by TDI when differences in electromechanical activation between LV walls were > 65 msec. LV systolic dysfunction was present in 16 patients (32%) by two-dimensional and in 20 patients (40%) by RT3DE. There was a good correlation between LV ejection fraction by two-dimensional and RT3DE (r = 0.75; P < 0.001). Fourteen (28%) patients had intraventricular dyssynchrony by TDI, while 12 (24%) had intraventricular dyssynchrony by RT3DE. There was a good agreement between LV dyssynchrony by TDI and RT3DE (Kappa = 0.735; P < 0.001). There was a negative correlation between LV ejection fraction and SDI obtained by RT3DE (r = -0.58; P < 0.001) CONCLUSIONS: In patients with CCAVB and long-term pacing, LV dyssynchrony occurred in one-third of patients and was related to LV dysfunction. There was a good correlation between dyssynchrony obtained by RT3DE and TDI.

Long-term Hemodialysis Corrects Left Ventricular Dyssynchrony in End-stage Renal Disease: A Study with Gated Technetium-99m Sestamibi Myocardial Perfusion Single-photon Emission Computed Tomography.

Left ventricular (LV) dyssynchrony is common in patients with end-stage renal disease (ESRD), and echocardiographic assessment has shown that it can be improved by a single session of hemodialysis (HD). The aim of this study was to assess the effects of chronic HD on LV dyssynchrony in patients ESRD by means of gated technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography (GSPECT) with phase analysis. Twelve patients with ESRD underwent GSPECT and echocardiography before the start of long-term HD (baseline) and 3 months later. In addition, 7 control subjects matched for age and sex underwent GSPECT and echocardiography within a 2-month period. To evaluate LV dyssynchrony, both histogram bandwidth (HBW) and phase standard deviation (PSD) were determined with phase analysis of GSPECT images. The end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction were also measured with GSPECT, and the LV mass index (LVMI) was measured with echocardiography. The LV dyssynchrony, volume, function, and mass were compared among control subjects, patients with ESRD at baseline, and patients with ESRD after 3 months of chronic HD. The LV dyssynchrony, volume, and mass at baseline were significantly greater in patients with ESRD than in control subjects (HBW, 65.5°±54.4° vs. 22.3°±7.5°, P<0.05; PSD, 21.0°±15.5° vs. 7.6°±5.5°, P<0.05; EDV, 105.7±29.2 vs. 72.3±13.9 mL, P<0.05; ESV, 44.3±22.1 vs. 20.9±10.3 mL, P<0.05; LVMI, 136.5±48.3 vs. 65.4±5.6 g/m(2), P<0.01). From baseline to the third month of chronic HD, there were significant increases in EDV (78.6±25.4 vs. 105.7±29.2 mL, P<0.01) and ESV (27.6±16.2 vs. 44.3±22.1 mL, P<0.01) and significant decreases in HBW (65.5°±54.4° vs. 31.0°±15.7°, P<0.01) and PSD (21.0°±15.5° vs. 10.0°±8.2°, P<0.01). Chronic HD decreased LV dyssynchrony and volume in patients with ESRD. Serial phase analysis of GSPECT images is a useful method of assessing the effects of long-term HD on LV dyssynchrony and volume in patients with ESRD.

Assessment of left ventricular dyssynchrony in patients with psoriasis.

Psoriasis is an inflammatory disorder, which has been reported to be associated with cardiovascular (CV) risks. Although increased CV risks in psoriasis are well established, there are no data about changes of contraction synchrony in psoriasis. Therefore, we aimed to study the left ventricular (LV) contraction synchrony in patients with psoriasis with narrow QRS and normal ejection fraction. Fifty patients with psoriasis and 50 age- and sex-matched control subjects were included in the study. LV dyssynchrony was investigated by color-coded tissue Doppler imaging. In the psoriasis group, the mean high-sensitive C-reactive protein values were significantly higher compared with the controls. Peak A velocity, deceleration time, isovolumetric relaxation time, and E/E' values were higher in the psoriasis group; however, E/A ratio and average Em were higher in the control group. LV systolic dyssynchrony parameters [including standard deviation of Ts of the 12 LV segments (Ts-SD-12), maximal difference in Ts between any two of the 12 LV segments, standard deviation of Ts of the six basal LV segments, and maximal difference in Ts between any two of the six basal LV segments] were found to be higher in the psoriasis group. The patients with ventricular dyssynchrony (a Ts-SD-12 >34.4ms) were higher in the psoriasis group than the control group (34% vs. 6%, P<0.01). In patients with psoriasis with normal ejection fractions and narrow QRS, LV systolic dyssynchrony is an early manifestation of heart involvement and may coexist with diastolic dysfunction.

SAT0173 Assessment of Left Ventricular Dyssynchrony in Patients with Familial Mediterranean Fever

BackgroundFamilial Mediterranean fever (FMF) is a disease characterized by recurrent and sustained increased inflammatory activity. Various clinical and subclinical cardiovascular involvements have been reported in FMF patients. However, there is...

Quantification of left ventricular dyssynchrony in patients with systolic dysfunction: a comparison of circumferential strain MR-tagging metrics.

To define which circumferential strain MR-tagging metrics of left intraventricular dyssynchrony better identifies patients with systolic dysfunction against control subjects. One hundred fifty subjects were studied: (i) controls with ejection fraction (EF) > 55% (n = 84), (ii) patients with EF ≤ 55% not eligible for cardiac resynchronization therapy (CRT) (n = 52), and (iii) patients eligible for CRT according to the ESC guidelines (n = 14). Tagging cine MR-based circumferential filtered strain curves were extracted. Six dyssynchrony indices were studied: standard deviation (SD) of peak strain (SD_Ecc_ES), SD of time-to-peak (SD_TTP), strain delay index (LIM), regional variance vector (RVV), circumferential uniformity ratio estimate (CURE), and uniformity of strain TTP (US_TTP). All metrics show significant differences between the three groups (ANOVA, P < 10(-4) ) and are correlated with EF. Significantly higher AUC values of ROC curves between patients with normal vs. decreased EF were obtained with SD_TTP (0.998) and CURE (0.995). Agreement among different methods was fair to good (kappa 0.32 to 0.89). Interobserver variability was best for CURE (1.2%) and US_TTP (0.8%) while more than 3-times larger for other metrics. SD_TTP and CURE are the most discriminant dyssynchrony metrics for systolic dysfunction. However, taking into account the method's variability argues in favor of indices of uniformity of the strain, ie, CURE and US_TTP.

Left ventricular dyssynchrony in patients with heart failure and preserved ejection fraction

Mechanical dyssynchrony has been postulated to play a pathophysiologic role in heart failure with preserved ejection fraction (HFpEF). We quantified left ventricular (LV) systolic dyssynchrony in 130 HFpEF patients with NYHA class II-IV symptoms, ejection fraction (EF) ≥45%, and NT-proBNP levels >400 pg/mL enrolled in the PARAMOUNT trial, and compared them to 40 healthy controls of similar age and gender. Dyssynchrony was assessed by 2D speckle tracking as standard deviation (SD) of time to peak longitudinal systolic strain in 12 ventricular segments and related to measures of systolic and diastolic function. Heart failure with preserved ejection fraction patients (62% women, mean age of 71 ± 9 years, body mass index of 30.2 ± 5.9 kg/m(2), systolic blood pressure 139 ± 15 mmHg) demonstrated significantly greater dyssynchrony than controls (SD of time to peak longitudinal strain; 90.6 ± 50.9 vs. 56.4 ± 33.5 ms, P < 0.001), even in the subset of patients (n = 63) with LVEF ≥55% and narrow QRS (≤100 ms). Among HFpEF patients, dyssynchrony was related to wider QRS interval, higher LV mass, and lower early diastolic tissue Doppler myocardial velocity (E'). Greater dyssynchrony remained significantly associated with worse diastolic function even after restricting the analysis to patients with EF≥55% and adjusting for age, gender, systolic blood pressure, LV mass index, and LVEF. Heart failure with preserved EF is associated with greater mechanical dyssynchrony compared with healthy controls of similar age and gender. Within an HFpEF population, the severity of dyssynchrony is related to the width of QRS complex, LV hypertrophy, and diastolic dysfunction.

The prognostic value of mechanical left ventricular dyssynchrony in patients with acute coronary syndrome

BackgroundEchocardiography is a well-established tool for risk stratification in patients with acute coronary syndrome (ACS). ACS has significant impact on LV dyssynchrony, and detrimental effects on systolic function and long term outcome. The aims of this study were to determine whether LV dyssynchrony carries any predictive information in an unselected ACS population and to evaluate if it has any incremental value to the information given from conventional echocardiographic measurements.MethodsThe study included 227 consecutive ACS patients. Primary endpoint was the composite of death, new MI, or rehospitalisation due to heart failure. Dyssynchrony was measured as intersegmental variation of time to peak strain, the post systolic index (PSI) and myocardial performance index (MPI) with the standard deviation and difference between lowest and highest value (delta) expressing the amount of dyssynchrony. Septal-lateral delay was also tested. All dyssynchrony parameters were compared with Ejection fraction (EF).ResultsThe median follow up time was 53 months. 85 patients reached the combined endpoint. Patients with and without a subsequent combined endpoint differed significantly regarding calculated SD: s and delta-value for PSI, time to peak 2D-strain and MPI but not regarding septal-lateral delay. In ROC-analysis none of the dyssynchrony parameters had larger AUC than EF. When adjusting for traditional risk factors none of the dyssynchrony parameters remained associated with outcome, whereas EF still did.ConclusionLV dyssynchrony seem to have significant prognostic information in patient with acute coronary syndrome but in comparison to conventional parameters such as EF there is no incremental value of this information.

Usefulness of Real‐time 3‐Dimensional Echocardiography to Identify and Quantify Left Ventricular Dyssynchrony in Patients With Kawasaki Disease

The role of left ventricular (LV) dyssynchrony in Kawasaki disease is unknown. This study sought to establish values for real-time 3-dimensional (3D) echocardiographically derived LV dyssynchrony parameters and identify and quantify LV dyssynchrony in patients with Kawasaki disease. Forty patients hospitalized for Kawasaki disease were analyzed retrospectively, and 40 sex- and age-matched healthy control volunteers were also enrolled. The systolic dyssynchrony index (percentage of the cardiac cycle) from 16 and 12 LV segments on real-time 3D echocardiography was analyzed to calculate LV dyssynchrony (defined as the standard deviation of the time to reach the minimum systolic volume for 16 LV segments) according to a 17-segment model. We analyzed the 3D LV ejection fraction (LVEF), end-diastolic volume, and end-systolic volume in the patients with Kawasaki disease compared to the controls. The 16-segment systolic dyssynchrony index ± SD was significantly higher in the patients with Kawasaki disease: 2.73% ± 0.96% compared to 2.01% ± 0.85% in the controls (P < .05). The 12-segment systolic dyssynchrony index in the patients with Kawasaki disease was 2.65% ± 0.93% compared to 1.98% ± 0.81% in the controls (P< .05). Patients with Kawasaki disease and an LVEF of less than 50% had a significantly higher systolic dyssynchrony index compared to patients with an LVEF of 50% or greater (2.89% ± 0.79% versus 2.26% ± 0.73%; P < .05). The LVEF measured by echocardiography was decreased in the patients with Kawasaki disease, and global systolic function was impaired. The LVEF measured by a biplane method was sufficiently related to the LVEF measured by echocardiography. Real-time 3D echocardiography is a noninvasive and feasible method for identifying and evaluating LV dyssynchrony in children with Kawasaki disease. Left ventricular dyssynchrony is significantly impaired and related to LV systolic function in patients with Kawasaki disease.

Is phase analysis by gated F-18 FDG PET/CT an alternative for the assessment of left ventricular dyssynchrony in patients with coronary artery disease?

Is phase analysis by gated F-18 FDG PET/CT an alternative for the assessment of left ventricular dyssynchrony in patients with coronary artery disease?