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Left ventricular dyssynchrony: a dynamic condition

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Abstract

Left ventricular dyssynchrony (LVD) is common in heart failure patients with LV systolic dysfunction. Contrary to what it could be expected, LVD is not a stable phenomenon. Various conditions (inducible ischemia, exercise, drug administration) may significantly alter the presence and the magnitude of LVD, which could per se modulate response to treatment for heart failure. LVD can be evaluated using validated Doppler-echocardiographic techniques as tissue Doppler imaging. Exercise and dobutamine stress echocardiography can be used tests to unmask LVD. Changes in LV synchronicity during stress test occur independently of inducible ischemia and irrespective of QRS width. The degree of LVD varies substantially from patient to patient. The dynamic increase in LVD represents a strong contributor: (1) to exercise-induced changes in mitral regurgitation, (2) to limitation of stroke volume adaptation during exercise, and (3) to exertional dyspnea. Whether dynamic LVD might independently affect the outcome has not yet been demonstrated. In the setting of CRT, the assessment of dynamic LVD might help patient selection, predict the magnitude of response, and optimize pacing delivery during exercise. Further longitudinal studies are required to confirm the value of assessing dynamic LVD.

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Abbreviations

LV:

Left ventricle

LVD:

Left ventricular dyssynchrony

MR:

Mitral regurgitation

CRT:

Cardiac resynchronisation therapy

References

  1. Yu CM, Lin H, Zhang Q et al (2003) High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration. Heart 89:54–60

    Article  PubMed  Google Scholar 

  2. Ghio S, Constantin C, Klersy C et al (2004) Interventricular and intraventricular dyssynchrony are common in heart failure patients, regardless of QRS duration. Eur Heart J 25:571–578

    Article  PubMed  Google Scholar 

  3. Cleland J, Freemantle N, Ghio S et al (2008) Predicting the long-term effects of cardiac resynchronization therapy on mortality from baseline variables and the early response a report from the CARE-HF (cardiac resynchronization in heart failure) trial. J Am Coll Cardiol 52:438–445

    Article  PubMed  Google Scholar 

  4. Bax JJ, Bleeker GB, Marwick TH et al (2004) Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. J Am Coll Cardiol 44:1834–1840

    Article  PubMed  Google Scholar 

  5. Cleland JG, Cullington D, Khaleva O et al (2008) Cardiac resynchronization therapy: dyssynchrony imaging from a heart failure perspective. Curr Opin Cardiol 23:634–645

    Article  PubMed  Google Scholar 

  6. Lancellotti P, Stainier PY, Lebois F et al (2005) Effect of dynamic left ventricular dyssynchrony on dynamic mitral regurgitation in patients with heart failure due to coronary artery disease. Am J Cardiol 96:1304–1307

    Article  PubMed  Google Scholar 

  7. Chattopadhyay S, Alamgir MF, Nikitin NP et al (2008) The effect of pharmacological stress on intraventricular dyssynchrony in left ventricular systolic dysfunction. Eur J Heart Fail 10:412–420

    Article  PubMed  Google Scholar 

  8. Kang SJ, Lim HS, Choi BJ et al (2008) The impact of exercise-induced changes in intraventricular dyssynchrony on functional improvement in patients with nonischemic cardiomyopathy. J Am Soc Echocardiogr 21:948–953

    Article  PubMed  Google Scholar 

  9. Kurita T, Onishi K, Dohi K et al (2007) Impact of heart rate on mechanical dyssynchrony and left ventricular contractility in patients with heart failure and normal QRS duration. Eur J Heart Fail 9:637–643

    Article  PubMed  Google Scholar 

  10. Lafitte S, Bordachar P, Lafitte M et al (2006) Dynamic ventricular dyssynchrony: an exercise-echocardiography study. J Am Coll Cardiol 47:2253–2259

    Article  PubMed  Google Scholar 

  11. Rocchi G, Bertini M, Biffi M et al (2009) Exercise stress echocardiography is superior to rest echocardiography in predicting left ventricular reverse remodelling and functional improvement after cardiac resynchronization therapy. Eur Heart J 30:89–97

    Article  PubMed  Google Scholar 

  12. D’Andrea A, Caso P, Cuomo S et al (2007) Effect of dynamic myocardial dyssynchrony on mitral regurgitation during supine bicycle exercise stress echocardiography in patients with idiopathic dilated cardiomyopathy and ‘narrow’ QRS. Eur Heart J 28:1004–1011

    Article  PubMed  Google Scholar 

  13. Wang YC, Hwang JJ, Yu CC et al (2008) Provocation of masked left ventricular mechanical dyssynchrony by treadmill exercise in patients with systolic heart failure and narrow QRS complex. Am J Cardiol 101:658–661

    Article  PubMed  Google Scholar 

  14. Izumo M, Lancellotti P, Suzuki K et al (2009) Three-dimensional echocardiographic assessments of exercise-induced changes in left ventricular shape and dyssynchrony in patients with dynamic functional mitral regurgitation. Eur J Echocardiogr 10:961–967

    Article  PubMed  Google Scholar 

  15. Parsai C, Baltabaeva A, Anderson L et al (2009) Low-dose dobutamine stress echo to quantify the degree of remodelling after cardiac resynchronization therapy. Eur Heart J 30:950–958

    Article  PubMed  Google Scholar 

  16. Piérard LA, Lancellotti P (2006) Left ventricular dyssynchrony and dynamic functional mitral regurgitation: relationship or association? Eur Heart J 27:638–640

    Article  PubMed  Google Scholar 

  17. Piérard LA, Lancellotti P (2004) The role of ischemic mitral regurgitation in the pathogenesis of acute pulmonary edema. N Engl J Med 351:1627–1634

    Article  PubMed  Google Scholar 

  18. Cleland JG, Daubert JC, Erdmann E et al (2005) Cardiac resynchronization-heart failure (CARE-HF) study investigators. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 352:1539–1549

    Article  PubMed  CAS  Google Scholar 

  19. Authors/Task Force Members, Vardas PE, Auricchio A et al (2007) Guidelines for cardiac pacing and cardiac resynchronization therapy: The task force for cardiac pacing and cardiac resynchronization therapy of the European society of cardiology. Developed in collaboration with the European heart rhythm association. Eur Heart J 28:2256–2295

    Article  PubMed  Google Scholar 

  20. Abraham WT, Fisher WG, Smith AL et al (2002) MIRACLE study group. Multicenter InSync randomized clinical evaluation. Cardiac resynchronization in chronic heart failure. N Engl J Med 346:1845–1853

    Article  PubMed  Google Scholar 

  21. Chung ES, Leon AR, Tavazzi L et al (2008) Results of the predictors of response to CRT (PROSPECT) trial. Circulation 117:2608–2616

    Article  PubMed  Google Scholar 

  22. Achilli A, Sassara M, Ficili S et al (2003) Long-term effectiveness of cardiac resynchronization therapy in patients with refractory heart failure and “narrow” QRS. J Am Coll Cardiol 17(42):2117–2124

    Article  Google Scholar 

  23. Beshai JF, Grimm RA, Nagueh SF et al (2007) RethinQ study investigators cardiac-resynchronization therapy in heart failure with narrow QRS complexes. N Engl J Med 357:2461–2471

    Article  PubMed  CAS  Google Scholar 

  24. Moonen ML, O’Connor K, Magne J et al (2010) Stress echocardiography for selecting potential responders to cardiac resynchronization therapy. Heart 96:1142–1146

    Article  PubMed  Google Scholar 

  25. Madaric J, Vanderheyden M, Van Laethem C et al (2007) Early and late effects of cardiac resynchronization therapy on exercise-induced mitral regurgitation: relationship with left ventricular dyssynchrony, remodelling and cardiopulmonary performance. Eur Heart 28:2134–2141

    Article  Google Scholar 

  26. Lancellotti P, Mélon P, Sakalihasan N et al (2004) Effect of cardiac resynchronization therapy on functional mitral regurgitation in heart failure. Am J Cardiol 94:1462–1465

    Article  PubMed  Google Scholar 

  27. Bordachar P, Lafitte S, Reuter S et al (2006) Echocardiographic assessment during exercise of heart failure patients with cardiac resynchronization therapy. Am J Cardiol 97:1622–1625

    Article  PubMed  Google Scholar 

  28. Lancellotti P, Senechal M, Moonen M et al (2009) Myocardial contractile reserve during exercise predicts left ventricular reverse remodelling after cardiac resynchronization therapy. Eur J Echocardiogr 10:663–668

    Article  PubMed  Google Scholar 

  29. Lancellotti P, Cosyns B, Piérard LA (2008) Dynamic left ventricular dyssynchrony contributes to B-type natriuretic peptide release during exercise in patients with systolic heart failure. Europace 10:496–501

    Article  PubMed  Google Scholar 

  30. Sénéchal M, Lancellotti P, Magne J et al (2010) Impact of mitral regurgitation and myocardial viability on left ventricular reverse remodeling after cardiac resynchronization therapy in patients with ischemic cardiomyopathy. Am J Cardiol 106:31–37

    Article  PubMed  Google Scholar 

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Correspondence to Patrizio Lancellotti.

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Marie Moonen is a Research Fellow of the Belgian F.R.S.-FNRS.

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Lancellotti, P., Moonen, M. Left ventricular dyssynchrony: a dynamic condition. Heart Fail Rev 17, 747–753 (2012). https://doi.org/10.1007/s10741-011-9275-x

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  • DOI: https://doi.org/10.1007/s10741-011-9275-x

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