Echocardiographic assessment of left ventricular dyssynchrony and correlation with QRS width in chronic heart failure
Zakhama, L.; Neffati, S.; Boussabeh, E.; Boukhris, B.; Saad, R.; Jendoubi, A.; Bennour, E.; BenYoussef, S.
La Tunisie Medicale 88(4): 234-239
2010
ISSN/ISBN: 0041-4131 PMID: 20446255 Document Number: 639897
Echocardiographic parameters of mechanical dyssynchrony may improve patients selection for cardiac resynchronisation therapy in chronic heart failure. This study aimed to define the prevalence of inter, intra and atrio-ventricular dyssynchrony in heart failure patients with different QRS duration and to evaluate inter and intra-observer variability in collecting different echocardiographic dyssynchony parameters. Twenty patients with chronic heart failure of any origin, NYHA functional class II-III with LVEF < 40%, were evaluated by complete echocardiographic examination including tissue Doppler imaging (DTI) and Tissue Tracking. Three patients had an atrio-ventricular dyssynchrony with a mean left ventricular filling time to cardiac cycle of 33 +/- 5%. Six patients had an interventricular mechanical delay (IVMD) > or = 40 milliseconds, all of them had a QRS duration > or = 120 milliseconds. Overall, no statistically significant correlation was found between IVMD and QRS duration (r = 0.35, p = 0.4). The mean septal to posterior wall-motion delay (SPWMD) was 83 +/- 64 ms. 7 patients had SPWMD > or = 130 ms. The baseline QRS duration did not correlate with SPWMD (p = 0.7). The mean LV dyssynchrony determined by deltaS-peak was 74 +/- 42 ms. Seven patients had LV dyssynchrony. Linear regression did not demonstrate a relation between QRS width and intraventricular dyssynchrony (p = 0.34). There was no concordance between intra-ventricular spatial or longitudinal dyssynchrony determined by DTI method and by Tissue Tracking (p = 0.3 and 0.6 respectively). The intraobserver reproducibility of LVFT/RR, IVMD and deltaS-peak (ICC = 0.99, 0.98 and 0.99, respectively), as well as the interobserver reproducibility (ICC: 0.96, 0.94 and 0.92, respectively), were very high. However, we observed a high variability for SPWMD measure (ICC = 0.27, p = 0.31). Mechanical dyssynchrony did not correlate with QRS duration, despite the poor variability in collecting different echocardiographic parameters.
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