Evaluation of Cardiac Mechanical Dyssynchrony in Heart Failure Patients Using Current Echo-Doppler Modalities

Abstract

BACKGROUND Current guidelines indicate electrical dyssynchrony as the major criteria for selecting patients for cardiac resynchronization therapy, and 25–35% of patients exhibit unfavorable responses to cardiac resynchronization therapy (CRT). We aimed to evaluate different cardiac mechanical dyssynchrony parameters in heart failure patients using current echo-Doppler modalities and we analyzed their association with electrical dyssynchrony. METHODS The study included 120 heart failure with reduced ejection fraction (HFrEF) who underwent assessments for left ventricular mechanical dyssynchrony (LVMD) and interventricular mechanical dyssynchrony (IVMD). RESULTS Patients were classified according to QRS duration: group I with QRS < 120 ms, group II with QRS 120–149 ms, and group III with QRS ≥ 150 ms. Group III had significantly higher IVMD, LVMD indices, TS-SD speckle-tracking echocardiography (STE) 12 segments (standard deviation of time to peak longitudinal strain speckle tracking echocardiography in 12 LV-segments), and LVMD score compared with group I and group II. Group II and group III were classified according to QRS morphology into left bundle branch block (LBBB) and non-LBBB subgroups. LVMD score, TS-SD 12 TDI, and TS-SD 12 STE had good correlations with QRS duration. CONCLUSIONS HFrEF patients with wide QRS duration (> 150 ms) had more evident LVMD compared with patients with narrow or intermediate QRS. Those patients with intermediate QRS duration (120–150 ms) had substantial LVMD assessed by both TDI and 2D STE, regardless of QRS morphology. Subsequently, we suggest that LVMD indices might be employed as additive criteria to predict CRT response in that patient subgroup. Electrical and mechanical dyssynchrony were strongly correlated in HFrEF patients.

Parameters of the mitral apparatus in patients with ischemic and nonischemic dilated cardiomyopathy

“…The presence of pre-systolic septal contraction (septal flash) and apical rocking as markers of left bundle branch block dyssynchrony, along with time to peak longitudinal strain, LV remodeling, and sMR, are the main clue parameters to be depicted as adjunctive to the guideline. 63,64 Cardiac magnetic resonance imaging can also provide complementary information to echocardiography in patients with MR. This method has emerged as a new technique in the evaluation of these patients and may be useful in the assessment of the unclear severity of MR measured by echocardiography.…”

“…The presence of pre-systolic septal contraction (septal flash) and apical rocking as markers of left bundle branch block dyssynchrony, along with time to peak longitudinal strain, LV remodeling, and sMR, are the main clue parameters to be depicted as adjunctive to the guideline. 63 , 64 …”

The Role of Echocardiography in Evaluating Cardiovascular Diseases in Patients with Diabetes Mellitus

“…Additional imaging modalities such as cardiac magnetic resonance imaging and cardiac computed tomographic angiography can provide information if routine transthoracic echocardiography is unavailable or falls short in providing sufficient information [ 57 - 59 ]. If a patient with dyspnea only on exertion and suspected HFpEF has normal echocardiographic results at rest, exercise stress echocardiography may be warranted to uncover exercise-induced hemodynamic abnormalities such as diastolic dysfunction or pulmonary hypertension [ 60 , 61 ].…”

Correlation Between Electrical and Mechanical Dyssynchrony in Patients With Heart Failure With Reduced Ejection Fraction

“…In this issue of the Journal of Cardiovascular Imaging , Rehab et al 9) comprehensively evaluated mechanical dyssynchrony parameters, according to electrical dyssynchrony, using echo-Doppler modality in patients with heart failure with reduced ejection fraction (HFrEF). They compared various Echo-Doppler parameters that indicated mechanical dyssynchrony by classifying the patients into three groups, based on the QRS width on the 12-lead electrocardiogram (ECG) for patients with HFrEF.…”