Concordance between QRS duration & left ventricular mechanical dyssynchrony in patients with severe LV dysfunction and its relation to its etiology
Keywords:
Heart Failure, Cardiac Resynchronization Therapy, Left Ventricular Dysfunction, Coronary Artery Bypass Surgery, Septal to Posterior Wall Motion Delay, Interventricular Mechanical Delay, Percutaneous Coronary Intervention, Guideline Derived Medical TherapyAbstract
Objective: This study aimed to compare the relationship between QRS duration (Electrical dyssynchrony) and conventional ECHO measures (Mechanical dyssynchrony) done in our hospital and other factors relating to this dyssynchrony. Materials & Methods: This is an analytical cross-sectional study and it was conducted for a period of two years conducted among the severe Left ventricular (LV) dysfunction patients with complete Left Bundle Branch Block (LBBB). Correlation coefficient was used to study the relationship between electrical and mechanical dyssynchrony. t test was used to study the difference among the means between the two variables. Results: Our results showed that (i) Electrical dyssynchrony exists similarly among the subjects irrespective of the NYHA classification and MR grading, (ii) Proportion of patients with QRS duration less than and more than or equal to 160 ms among patients with different mechanical dyssynchrony parameters were not statistically significant, (iii) All patients with septal to lateral delay more than 65 ms have QRS duration more than or equal to 160 ms, (iv) None of the parameters of mechanical dyssynchrony have a significant correlation with QRS duration, (v) Ischemic subjects have a strong correlation between the mechanical and electrical dyssynchrony parameters except septal to lateral delay parameter and interventricular mechanical dyssynchrony, however there is no correlation between electrical and mechanical dyssynchrony among the non-ischemic subjects, (vii) There is a weak relationship between QRS duration and measured BNP, mean PA pressure, LVESV, LVESV and BNP. Conclusion: Our results revealed that there is a strong correlation between electrical and certain parameters of mechanical dyssynchrony among the patients with severe LVD with complete LBBB with ischemic etiology.
References
Kass DA, Chen CH, Curry C, et al. Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay. Circulation 1999;99:1567–73.
Auricchio A, Stellbrink C, Block M, et al. The effect of pacing chamber and atrioventricular delay on acute systolic function of paced patients with congestive heart failure. Circulation 1999;99:2993–3001.
Auricchio A, Ding J, Spinelli JC, et al. Cardiac resynchronization therapy restores optimal atrioventricular mechanical timing in heart failure patients with ventricular conduction delay. J Am Coll Cardiol 2002;39:1163–9.
Auricchio A, Stellbrink C, Sack S, et al. Long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay. J Am Coll Cardiol 2002;39:2026–33.
Abraham WT, Fisher WG, Smith AL, et al. Cardiac resynchronization in chronic heart failure. N Engl J Med 2002;346:1902–5.
Stellbrink C, Breithardt O, Franke A, et al. Impact of cardiac resynchronization therapy using hemodynamically optimized pacing on left ventricular remodeling in patients with congestive heart failure and ventricular conduction disturbance. J Am Coll Cardiol 2001;38:1957–65.
St John Sutton MG, Plappert T, Abraham WT, et al. Effect of cardiac resynchronization therapy on left ventricular size and function in chronic heart failure patients. Circulation 2003;107:1985–90.
Yu CM, Chau E, Sanderson JE, et al. Tissue Doppler echocardiographic evidence of reverse remodeling and improved synchronicity by simultaneously delaying regional contraction after biventricular pacing therapy in heart failure. Circulation 2002;105:438–45.
Chung ES, Leon AR, Tavazzi L, Sun JP, Nihoyannopoulos P, Merlino J, Abraham WT, Ghio S, Leclercq C, Bax JJ, Yu CM, Gorcsan J III, St John SM, De Sutter J, Murillo J. Results of the Predictors of Response to CRT (PROSPECT) trial. Circulation 2008;117:2608–2616.
Tang, Wai Hong Wilson, et al. "Relation of mechanical dyssynchrony with underlying cardiac structure and performance in chronic systolic heart failure: implications on clinical response to cardiac resynchronization." Europace 10.12 (2008): 1370-1374.
Haghjoo, Majid, et al. "Prevalence of mechanical dyssynchrony in heart failure patients with different QRS durations." Pacing and clinical electrophysiology 30.5 (2007): 616-622.
Ghio S, Chung E, Leon A, et al. Predictors of Response to Resynchronization Therapy. Presented at the European Society of Cardiology Meeting. Vienna, Austria. September 4, 2007 [abstract] 2007.
Ghio S, Constantin C, Klersy C, et al. Interventricular and intraventricular dyssynchrony are common in heart failure patients, regardless of QRS duration. Eur Heart J 2004;25:571-578.
Bax JJ, Bleeker GB, Marwick TH, Molhoek SG, Boersma E, Steendijk P, van der Wall EE, Schalij MJ. Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. J Am Coll Cardiol. 2004;44:1834 –1840.
Bax JJ, Marwick TH, Molhoek SG, Bleeker GB, van Erven L, Boersma E, Steendijk P, van der Wall EE, Schalij MJ. Left ventricular dyssynchrony predicts benefit of cardiac resynchronization therapy in patients with end-stage heart failure before pacemaker implantation. Am J Cardiol. 2003;92:1238 –1240.
Bleeker GB, Schalij MJ, Molhoek SG, Verwey HF, Holman ER, Boersma E, Steendijk P, van der Wall EE, Bax JJ. Relationship between QRS duration and left ventricular dyssynchrony in patients with end-stage heart failure. J Cardiovasc Electrophysiol. 2004;15:544 –549.
Emkanjoo, Zahra, et al. "Frequency of inter-and intraventricular dyssynchrony in patients with heart failure according to QRS width." Europace 9.12 (2007): 1171-1176.
Tournoux, FranCOis, et al. "Concordance between mechanical and electrical dyssynchrony in heart failure patients: a function of the underlying cardiomyopathy?." Journal of cardiovascular electrophysiology 18.10 (2007): 1022-1027.
Götte, Marco JW, et al. "Myocardial Strain and Torsion Quantified by Cardiovascular Magnetic Resonance Tissue TaggingStudies in Normal and Impaired Left Ventricular Function." Journal of the American College of Cardiology 48.10 (2006): 2002-2011.
Raab, Stephan, et al. "Brain natriuretic peptide–a reliable parameter for the effectiveness of cardiac resynchronization therapy after coronary artery bypass grafting." Interactive cardiovascular and thoracic surgery 5.4 (2006): 439-443.
Pitzalis, Maria Vittoria, et al. "Prognostic value of brain natriuretic peptide in the management of patients receiving cardiac resynchronization therapy." European journal of heart failure 8.5 (2006): 509-514.
Downloads
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Dr. Arun Kaushik P
This work is licensed under a Creative Commons Attribution 4.0 International License.
CC BY License
