Clinical investigation
Ventricular dyssynchrony
Relationship Between Intraventricular Cardiac Asynchrony and Degree of Systolic Dysfunction

https://doi.org/10.1016/j.echo.2007.08.011Get rights and content

Objectives

Cardiac asynchrony is an area of study becoming more relevant in the evaluation and management of heart failure. Our aim was to determine the prevalence of cardiac asynchrony by Doppler echocardiography and to evaluate its relationship with the degree of left ventricular (LV) systolic dysfunction.

Methods

A total of 316 consecutive patients with LV ejection fraction less than 40% were enrolled. We divided them into 3 groups according to the degree of LV dysfunction: 31% to 40%, 21% to 30%, and less than 20%. Intraventricular asynchrony was evaluated using two methods: (1) measurement of the septal to posterior wall-motion delay (cut-off point 130 milliseconds); and (2) measurement of the difference between time from Q wave to LV ejection end, and the time from Q wave to the end of the systolic wave of the most delayed basal segment by Doppler tissue imaging (ejection- Doppler tissue imaging time; cut-off point 50 milliseconds).

Results

Mean age was 62.14 ± 13.5 years (75.7% men). No differences were found among clinical electrical and echocardiographic variables among the groups. Furthermore, no relationship was found between the existence of intraventricular cardiac asynchrony and the degree of LV systolic dysfunction. These were similar in patients with ischemic dilated cardiomyopathy and nonischemic dilated cardiomyopathy.

Conclusions

The degree of LV systolic dysfunction and its origin are not related to the presence of cardiac asynchrony. A specific echocardiographic Doppler study must always be performed to assess the existence of cardiac asynchrony in those who are candidates to resynchronization therapy.

Section snippets

Patient Population

A total of 316 consecutive patients referred for echocardiographic Doppler study comprised the study group. All of them had a LV ejection fraction (LVEF) assessed by means of Simpson’s method (4- and 2-chamber volumes were averaged) of less than 40%. Exclusion criteria were: patients on CRT or paced, atrial fibrillation with rapid ventricular response, unwillingness of the patient to be enrolled, inaccurate determination of LVEF, bad acoustic window, and severe valvular heart disease. Patients

Results

Mean age of patients was 62.14 ± 13.5 years. A total of 220 (69.6%) were men. The proportion of men was similar in the 3 groups of patients and in the control group (18 [62.1%], 101 [75.9%], 87 [77.7%], and 32 [71.1%] in control, LVEF 31%-40%, LVEF 21%-30%, and LVEF <20% groups, respectively). Table 1 shows the baseline characteristics of the 3 groups.

There were significant differences between the New York Heart Association classes and the level of systolic dysfunction. Most patients with LVEF

Discussion

The results of this study enhance the usefulness of Doppler echocardiography in the assessment of mechanical cardiac asynchrony.14, 15 Our findings show that the prevalence of intraventricular cardiac asynchrony does not depend on the degree of LV systolic dysfunction. Furthermore, when the results are analyzed taking into account the origin of the systolic dysfunction, the findings reinforce the previous results: neither in the ischemic group nor in the nonischemic group is there any

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