Echocardiographic Assessment of the Interventricular Delay of Activation and Correlation to the QRS Width in Dilated Cardiomyopathy

Rouleau, Frédéric; Merheb, M.; Geffroy, Sylvie; Berthelot, J. M.; Chaleil, D; Dupuis, J.; Victor, Jacques; Geslin, Philippe

doi:10.1046/j.1460-9592.2001.01500.x

Cited by 152 publications

(116 citation statements)

References 12 publications

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“…However, electromechanical coupling assessment by conventional echocardiography remains difficult (20). Recently, the alteration of activation-contraction sequence in LV asynchronism was assessed by determining the delay from the onset of QRS (ECG) to the onset of DTI S m wave (Q-S m time) (24). After chronic hypoxia exposure and monocrotaline treatment, Q-S m time was significantly increased compared with control.…”

Section: Discussionmentioning

confidence: 99%

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Doppler tissue imaging in assessment of pulmonary hypertension-induced right ventricle dysfunction

Boissière¹,

Gautier²,

Machet³

et al. 2005

American Journal of Physiology-Heart and Circulatory Physiology

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-We aimed to assess the accuracy of Doppler tissue imaging (DTI) in detecting right ventricle (RV) dysfunction and electromechanical coupling alteration following pulmonary hypertension (PHT) in rat. PHT was induced by chronic hypoxia exposure (hypoxic PHT) or monocrotaline treatment (monocrotaline PHT). In both PHT models, we observed transparietal RV pressure increase and remodeling, including hypertrophy and dilation. Conventional echocardiography provided evidence for pulmonary outflow impairment with midsystolic notch and acceleration time decrease in PHT groups (21.7 Ϯ 1.6 and 13.2 Ϯ 2.9 ms in hypoxic and monocrotaline PHT groups vs. 28.1 Ϯ 1.0 ms in control). RV shortening fraction was decreased in the monocrotaline PHT group compared with the hypoxic PHT and control groups. Combining conventional Doppler and DTI was more helpful to detect RV diastolic dysfunction in the monocrotaline PHT group (E/Ea ratio ϭ 17.0 Ϯ 1.4) compared with the hypoxic PHT and control groups (11.5 Ϯ 0.7 and 10.2 Ϯ 0.4, respectively). Tei index measured using DTI highlighted global RV dysfunction in the monocrotaline PHT group (1.36 Ϯ 0.24 vs. 0.92 Ϯ 0.05 and 0.86 Ϯ 0.05 in the hypoxic PHT and control groups, respectively). Q-S m time measured from the onset of Q wave to the onset of DTI S m wave was increased in both PHT groups. PHT-induced electromechanical coupling alteration was confirmed by in vitro activation-contraction delay measurements on isolated RV papillary muscle, and both Q-S m time and activation-contraction delay were correlated with PHT severity. We demonstrated that Q-Sm time measured in DTI was an easily and convenient index to detect early RV electromechanical coupling alteration in both moderate and severe PHT. echocardiography; hypertrophy; right ventricular remodeling CHRONIC ALVEOLAR HYPOXIA, which often occurs in patients suffering from chronic obstructive pulmonary diseases, secondarily induces a sustained increase in pulmonary artery resistance. The subsequent pulmonary artery hypertension (PHT) leads to right ventricle (RV) pressure overload and hypertrophy (22).Conventional transthoracic echocardiography is widely used to detect PHT in humans and animal models (14, 18). The standard parameters are the RV free wall thickening recorded in time-motion (TM) mode, the presence of mild-systolic notch, and the acceleration time decrease in the pulmonary outflow spectrum recorded in pulsed-Doppler mode. Nevertheless, a more extensive assessment of PHT-induced RV dysfunction remains difficult using conventional echocardiography. Indeed, accuracy of RV systolic and diastolic functions assessment is limited by complex anatomy and geometry of the ventricle.The Tei index, which combines both systolic and diastolic parameters, was suggested to determine global myocardial performance (27). It has been used in the assessment of RV dysfunction, especially in PHT (26). In conventional pulsed Doppler, the Tei index derives from both isovolumic contraction and relaxation times (IVCT and IVRT) as well as ejection time of...

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Section: Discussionmentioning

confidence: 99%

“…On the other hand, DTI, which allows measurement of endocardial velocities, provides more accurate measurements of myocardial motion. The delay from the onset of Q wave (ECG) to the onset of DTI S m wave (Q-S m time) could be likened to the time for RV activation as previously used in left ventricle (LV) asynchrony prognosis (24).…”

mentioning

confidence: 99%

Doppler tissue imaging in assessment of pulmonary hypertension-induced right ventricle dysfunction

Boissière¹,

Gautier²,

Machet³

et al. 2005

American Journal of Physiology-Heart and Circulatory Physiology

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“…Yamada et al reported that progressive myocardial fibrosis leads to dyssynchronous activation of the left and right ventricles and a prolonged QRS duration. 15 Possible clinical consequences of ventricular asynchrony, which presents as prolonged QRS duration on ECG, include abnormal interventricular septal wall motion, a reduction in the peak rate of rise of LV pressure, reduced diastolic filling times, and prolonged duration of MR. These factors all appear to be associated with an unfavorable prognosis in heart failure.…”

Section: Qrs Durationmentioning

confidence: 99%

Prolonged QRS Duration and Severity of Mitral Regurgitation are Unfavorable Prognostic Markers of Heart Failure in Patients With Nonischemic Dilated Cardiomyopathy

Amiya

Tanabe

Ikari

et al. 2006

Circ J

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eart failure may be defined as the inability of the heart to meet the demands of the tissues, resulting in symptoms of fatigue or dyspnea on exertion progressing to dyspnea at rest. Patients with nonischemic dilated cardiomyopathy (NIDCM) constitute the largest group of myopathic disorders that are responsible for systolic heart failure. In most multicenter, randomized heart-failure trials, approximately one-third of the enrolled patients have NIDCM. The term NIDCM refers to a spectrum of heterogeneous myocardial disorders that are characterized by ventricular dilation and depressed myocardial contractility in the absence of abnormal loading conditions (such as hypertension or valvular disease) or ischemic heart disease.Angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs) and -blockers are the mainstay of treatment in patients with heart failure, irrespective of the etiology and severity of heart failure. ACEI/ARBs and -blockers have been shown to reverse left ventricular (LV) remodeling and improve dyspnea and exercise tolerance, reduce hospitalization rates, and reduce cardiovascular mortality.The prognosis of dilated cardiomyopathy (DCM) has been poor in the past, 1,2 but has improved since ACEI/ARBs Circulation Journal Vol.70, January 2006and -blockers have been widely used as treatment. Azuma et al reported that in Japan the calculated survival rate at 5 years was 90.0% in patients diagnosed with DCM after 1990 in contrast to 62.3% in patients diagnosed before 1989. 3 However, there are still some cases that remain difficult to treat despite the use of ACEI/ARBs and -blockers, and for these biventricular pacing or surgical interventions, such as heart transplantation or the Batista procedure, has been performed. Therefore, risk prediction in patients with NIDCM is crucial for selection of the best treatment strategy, but there were few reports restricted to cases of NIDCM for examining the predictive factors of heart failure.The purpose of this study was to evaluate various factors that might predict an adverse outcome in patients with NIDCM who were treated with ACEI/ARBs and/orblockers. Methods Patient SelectionWe identified 78 consecutive patients with NIDCM between 1997 and 2002. NIDCM was diagnosed by echocardiography, coronary angiography, and endomyocardial biopsy, according to the criteria proposed by the WHO/ISFC task force. NIDCM was defined as LV ejection fraction (LVEF) <0.40, a LV end-diastolic diameter (LVEDD) >55 mm on echocardiography, and the absence of significant coronary artery stenosis on angiography. Exclusion Background The goal of the present study was to identify predictors of event-free survival in nonischemic dilated cardiomyopathy (NIDCM) patients after administration of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) and -blockers. Methods and ResultsThe study group comprised 78 consecutive patients with NIDCM between 1997 and 2002. NIDCM was defined as ejection fraction (EF) <0.40 and left ventricular end-dias...

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Section: Ventricular Dyssynchronymentioning

confidence: 99%

“…A delay greater than 60 ms between those measurements indicates interventricular dyssynchrony. The limitation of such method is that those measurements are not taken simultaneously [20][21][22] .Another way to assess delay is through the M mode, in which the time between septal contraction and posterior wall contraction is measured ( fig. 2).…”

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confidence: 99%

Avaliação ecocardiográfica da terapia de ressincronização cardíaca

Silva¹,

Barretto²

2005

Arq. Bras. Cardiol.

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Heart failure is one of the major causes of mortality, morbidity, and hospitalization in patients older than 60 years, accounting for 1 to 2% of the total expenditure in the health sector in the United States (approximately 20 billion dollars per year!) 1,2 . Despite the great advances in therapy, the morbidity and mortality rates still remain high 3 . Cardiac resynchronization therapy (CRT) was introduced in the beginning of the 1990's and rapidly developed until its approval in 2001 by the FDA (Food and Drugs Administration) 4 .In the American Heart Association guidelines, CRT has been considered to be IIA evidence level 5 . Those guidelines were based on 2 large trials: the MUSTIC 6 and the MIRACLE 7 . In both, the inclusion criteria were similar: a) significant heart failure despite appropriate therapy; b) low ejection fraction; and c) broad QRS with left bundle-branch block pattern (duration>120 ms). Both studies have confirmed that CRT significantly improves symptoms, tolerance to exercise, and quality of life. Nevertheless, 20% to 30% of the patients do not improve with CRT 8 , emphasizing the need for new criteria of patients' selection.Recent studies have reported that mechanical dyssynchrony is not always related to electrical dyssynchrony 9,10 , and that the presence of ventricular dyssynchrony is the best predictor of a good response to resynchronization therapy. In reality, some patients with broad QRS may not have mechanical dyssynchrony while others with narrow QRS may [11][12][13] .Although QRS duration is a good prognostic marker for mortality in patients with heart failure and is present in more than 80% of the individuals in the 2 months preceding death 14,15 , studies comparing QRS alterations with the clinical outcome of patients seem to show little or no relation to prognosis 16 .These data suggest that electrocardiography may not be the best complementary diagnostic method for selecting candidates to CRT. Other imaging techniques, particularly the new methods for assessing ventricular function on echocardiography, seem to be better for selecting patients who will best respond to resynchronization therapy.Both the presence of broad QRS and the signs of interventricular dyssynchrony are predictors of hospitalization and severe cardiac events in patients with heart failure 17,18 . Ventricular dyssynchronyThe mechanism of dyssynchrony includes regional delays of both ventricular contraction and relaxation. The right ventricle contracts during left ventricular telediastole leading to a septal bulging towards the left ventricle. In addition, the delay in the activation of the papillary muscles causes, or worsens, mitral incompetence 19 . All such factors contribute to a reduction in the ejection fraction and a worsening of the clinical symptoms.Dyssynchrony may be inter-or intraventricular, and echocardiography may evaluate both types through several techniques.One way of evaluating interventricular dyssynchrony is by measuring the time between ventricular ejections. Conventional Doppler measure...

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Echocardiographic Assessment of the Interventricular Delay of Activation and Correlation to the QRS Width in Dilated Cardiomyopathy

Cited by 152 publications

References 12 publications

Doppler tissue imaging in assessment of pulmonary hypertension-induced right ventricle dysfunction

Doppler tissue imaging in assessment of pulmonary hypertension-induced right ventricle dysfunction

Prolonged QRS Duration and Severity of Mitral Regurgitation are Unfavorable Prognostic Markers of Heart Failure in Patients With Nonischemic Dilated Cardiomyopathy

Avaliação ecocardiográfica da terapia de ressincronização cardíaca

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