Europace Advance Access originally published online on November 6, 2008
Europace 2008 10(12):1370-1374; doi:10.1093/europace/eun296
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Cardiac resynchronization therapy
Relation of mechanical dyssynchrony with underlying cardiac structure and performance in chronic systolic heart failure: implications on clinical response to cardiac resynchronization
1 Section of Heart Failure and Cardiac Transplantation Medicine, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA; 2 Christchurch School of Medicine, Christchurch, New Zealand
Aims: The aim of this study is to describe the relationship between ventricular mechanical dyssynchrony (VMD) and echocardiographic indices of cardiac remodelling.
Methods and results: We evaluated 219 ambulatory patients with chronic systolic heart failure [left ventricular ejection fraction (LVEF) 
35%, New York Heart Association functional classes II–IV] who underwent echocardiographic evaluation. The presence of dyssynchrony was defined by Bader criteria (intra-VMD > 40 ms and/or inter-VMD > 38 ms). In our study cohort, 59% of patients had evidence of dyssynchrony (including 44% with intra-VMD and 38% with inter-VMD, and 20% with both). Inter-VMD correlated with QRS width (r = 0.48, P < 0.0001) better than intra-VMD (r = 0.24, P < 0.001). Higher inter-VMD was associated with less restrictive filling patterns (rank sums P = 0.012) and larger left ventricular end-diastolic dimension (LVEDD, rank sums P = 0.020), but intra-VMD values were similar across diastolic stages and LVEDD tertiles.
Conclusion: In chronic systolic heart failure, evidence of mechanical dyssynchrony is prevalent but the underlying cardiac structure and performance may influence the degree of inter-VMD more so than intra-VMD. Our data suggest that the extent of inter-VMD is directly related to the degree of dilatation of the heart but inversely to diastolic dysfunction.
Key Words: Intra-ventricular mechanical dyssynchrony, Inter-ventricular mechanical dyssynchrony, Cardiac resynchronization therapy, Heart failure
* Corresponding author. Tel: +1 216 444 2121; fax: +1 216 445 6165. E-mail address: tangw{at}ccf.org
Manuscript submitted 28 April 2008. Accepted after revision 9 October 2008.
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