Left ventricular mechanical dispersion in flow-gradient patterns of severe aortic stenosis with narrow QRS complex

Abstract

Patients with severe aortic stenosis are classified according to flow-gradient patterns. We investigated whether left ventricular (LV) mechanical dispersion, a marker of dyssynchrony and predictor of mortality, is associated with low-flow status in aortic stenosis. 316 consecutive patients with aortic stenosis and QRS duration < 120 ms were included in the retrospective analysis. Patients with severe aortic stenosis (aortic valve area ≤ 1.0 cm 2) were classified as normal-flow (NF; stroke volume index > 35 ml/m 2) high-gradient (HG; mean transvalvular gradient ≥ 40 mmHg) (n = 79), NF low-gradient (LG) (n = 62), low-flow (LF) LG ejection fraction (EF) ≥ 50% (n = 57), and LF LG EF < 50% (n = 23). Patients with moderate aortic stenosis (aortic valve area 1.5-1.0 cm 2 ; n = 95) served as comparison group. Mechanical dispersion (calculated as standard deviation of time from Q/S onset on electrocardiogram to peak longitudinal strain in 17 left ventricular segments) was similar in patients with NF HG (49.4 ± 14.7 ms), NF LG (43.5 ± 12.9 ms), LF LG EF ≥ 50% (47.2 ± 16.3 ms) and moderate aortic stenosis (44.2 ± 15.7 ms). In patients with LF LG EF < 50%, mechanical dispersion was increased (60.8 ± 20.7 ms, p < 0.05 vs. NF HG, NF LG, LF LG EF ≥ 50% and moderate AS). Mechanical dispersion correlated with global longitudinal strain (r = 0.1354, p = 0.0160) and heart rate (r = 0.1587, p = 0.0047), but not with parameters of aortic stenosis. Mechanical dispersion was similar among flow-gradient subgroups of severe aortic stenosis with preserved LVEF, but increased in patients with low-flow low-gradient and reduced LVEF. These findings indicate that mechanical dispersion is rather a marker of systolic myocardial dysfunction than of aortic stenosis.

Effect of the index of cardiac electrophysiological balance on major adverse cardiovascular events in patients with diabetes complicated with coronary heart disease

“…In addition, specific ECG abnormalities have been correlated with the occurrence of certain major adverse cardiac events (MACE) ( Ekeloef et al, 2016 ). For instance, extended QRS duration, QS pattern, and irregular ST-segment/T-wave have been linked to coronary heart disease (CHD) ( Yalin et al, 2023 ; Lavall et al, 2020 ). Increased QRS duration, left QRS-axis deviation, atypical ST-segment/T-wave, and tall R-wave have been associated with incident heart failure (HF) ( Lavall et al, 2020 ).…”

“…For instance, extended QRS duration, QS pattern, and irregular ST-segment/T-wave have been linked to coronary heart disease (CHD) ( Yalin et al, 2023 ; Lavall et al, 2020 ). Increased QRS duration, left QRS-axis deviation, atypical ST-segment/T-wave, and tall R-wave have been associated with incident heart failure (HF) ( Lavall et al, 2020 ). Concerning sudden cardiac arrest (SCA), abnormalities such as elongated PR duration, prolonged QRS duration, irregular T-wave, and tall R-wave have been identified as prognostic indicators ( Nissen et al, 2023 ).…”

Layer-specific strain and dyssynchrony index alteration in new-onset systemic lupus erythematosus patients without cardiac symptoms

“…PSD has been proven to be a relatively new and useful marker for the early detection of LVMD (17,18). Mounting evidence suggests that LVMD has an independent and incremental negative impact on myocardial mechanics and remodeling.…”