Evaluation of Cardiac Mechanical Dyssynchrony in Heart Failure Patients Using Current Echo-Doppler Modalities
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초록
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.
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.
참고문헌 (30)
- Glikson M, "2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy", Eur Heart J, 42, pp.3427~3520 (2021)
- Bank AJ, "Echocardiographic measurement of mechanical dyssynchrony in heart failure and cardiac resynchronization therapy", US Cardiol Rev, 7, pp.24~32 (2010)
- Kleijn SA, "A meta-analysis of left ventricular dyssynchrony assessment and prediction of response to cardiac resynchronization therapy by three-dimensional echocardiography", Eur Heart J Cardiovasc Imaging, 13, pp.763~775 (2012)
- Mor-Avi V, "Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics : ASE", EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography, 2011, pp.24, 277~313
- Dillikar MV, "Three-dimensional versus two-dimensional strain for the assessment of myocardial function : a case series", J Ind Acad Echocardiogr Cardiovasc Imaging, 1, pp.18~23 (2017)
- Yu CM, "Tissue Doppler imaging is superior to strain rate imaging and postsystolic shortening on the prediction of reverse remodeling in both ischemic and nonischemic heart failure after cardiac resynchronization therapy", Circulation, 110, pp.66~73 (2004)
- Bax JJ, "Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy", J Am Coll Cardiol, 44, pp.1834~1840 (2004)
- Yu CM, "Understanding nonresponders of cardiac resynchronization therapy--current and future perspectives", J Cardiovasc Electrophysiol, 16, pp.1117~1124 (2005)
- Oyenuga O, "Usefulness of echocardiographic dyssynchrony in patients with borderline QRS duration to assist with selection for cardiac resynchronization therapy", JACC Cardiovasc Imaging, 3, pp.132~140 (2010)
- Haghjoo M, "Prevalence of mechanical dyssynchrony in heart failure patients with different QRS durations", Pacing Clin Electrophysiol, 30, pp.616~622 (2007)
- Bleeker GB, "Relationship between QRS duration and left ventricular dyssynchrony in patients with end-stage heart failure", J Cardiovasc Electrophysiol, 15, pp.544~549 (2004)
- Ghio S, "Interventricular and intraventricular dyssynchrony are common in heart failure patients, regardless of QRS duration", Eur Heart J, 25, pp.571~578 (2004)
- Lang RM, "Recommendations for cardiac chamber quantification by echocardiography in adults : an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging", J Am Soc Echocardiogr, 28, pp.1~39 (2015)
- Yu CM, "High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration", Heart, 89, pp.54~60 (2003)
- Badano LP, "Left ventricular electromechanical delay in patients with heart failure and normal QRS duration and in patients with right and left bundle branch block", Europace, 9, pp.41~47 (2007)
- Montazeri M, "Assessment of left ventricular dyssynchrony in heart failure patients regarding underlying etiology and QRS duration", J Tehran Heart Cent, 6, pp.193~201 (2011)
- van Bommel RJ, "Site of latest activation in patients eligible for cardiac resynchronization therapy : patterns of dyssynchrony among different QRS configurations and impact of heart failure etiology", Am Heart J, 161, pp.1060~1066 (2011)
- Jiang FX, "Evaluation of left ventricular mechanical dyssynchrony in chronic heart failure patients by two-dimensional speckle tracking imaging", Kaohsiung J Med Sci, 29, pp.374~378 (2013)
- Tournoux F, "Concordance between mechanical and electrical dyssynchrony in heart failure patients : a function of the underlying cardiomyopathy?", J Cardiovasc Electrophysiol, 18, pp.1022~1027 (2007)
- Ahmed H, "QRS duration and echocardiographic evidence of left ventricular dyssynchrony in patients with left ventricular systolic dysfunction", J Coll Physicians Surg Pak, 20, pp.146~149 (2010)
- Lumens J, "Mechanistic evaluation of echocardiographic dyssynchrony indices : patient data combined with multiscale computer simulations", Circ Cardiovasc Imaging, 5, pp.491~499 (2012)
- Lumens J, "Comparative electromechanical and hemodynamic effects of left ventricular and biventricular pacing in dyssynchronous heart failure : electrical resynchronization versus left-right ventricular interaction", J Am Coll Cardiol, 62, pp.2395~2403 (2013)
- Brunet-Bernard A, "Combined score using clinical, electrocardiographic, and echocardiographic parameters to predict left ventricular remodeling in patients having had cardiac resynchronization therapy six months earlier", Am J Cardiol, 113, pp.2045~2051 (2014)
- Zhang Q, "Diverse patterns of longitudinal and radial dyssynchrony in patients with advanced systolic heart failure", Heart, 97, pp.574~578 (2011)
- Zhang Q, "Is mechanical dyssynchrony still a major determinant for responses after cardiac resynchronization therapy?", J Cardiol, 57, pp.239~248 (2011)
- Stankovic I, "Relationship of visually assessed apical rocking and septal flash to response and long-term survival following cardiac resynchronization therapy(PREDICT-CRT)", Eur Heart J Cardiovasc Imaging, 17, pp.262~269 (2016)
- Galli E, "Mechanical dyssynchrony in heart failure : Still a valid concept for optimizing treatment?", Arch Cardiovasc Dis, 110, pp.60~68 (2017)
- Behaghel A, "Electrocardiographic correlates of mechanical dyssynchrony in recipients of cardiac resynchronization therapy devices", Arch Cardiovasc Dis, 108, pp.617~625 (2015)
- Beela AS, "Assessment of mechanical dyssynchrony can improve the prognostic value of guideline-based patient selection for cardiac resynchronization therapy", Eur Heart J Cardiovasc Imaging, 20, pp.66~74 (2019)
- Risum N, "Mechanical dyssynchrony evaluated by tissue Doppler crosscorrelation analysis is associated with long-term survival in patients after cardiac resynchronization therapy", Eur Heart J, 34, pp.48~56 (2013)