Interventricular and intraventricular dyssynchrony are common in heart failure patients, regardless of QRS duration.

AIMS The study aimed at evaluating the prevalence of interventricular and intraventricular contractile dyssynchrony in heart failure patients with either normal or prolonged QRS duration. METHODS AND RESULTS Echocardiography and tissue Doppler imaging (TDI) were performed in 158 consecutive patients with advanced left ventricular dysfunction (LVEF<35%); 61 patients had a normal QRS duration (Group 1), 21 patients had left bundle branch block with a QRS duration between 120 and 150 ms (Group 2) and 76 patients had a QRS duration #10878;150 ms (Group 3). Interventricular dyssynchrony (defined by the presence of an interventricular mechanical delay greater than 40 ms) was found in 12.5%, 52.4% and 72% of patients in Group 1, 2 and 3, respectively (p < 0.001). Intraventricular dyssynchrony (defined by the presence of one or more differences greater than 50 ms among regional pre-ejection periods) was observed in 29.5%, 57.1% and 71% of patients in Group 1, 2 and 3, respectively (p < 0.001). No relationship was found between interventricular and intraventricular dyssynchrony. CONCLUSIONS A substantial proportion of heart failure patients with a slightly prolonged QRS or even with normal conduction may exhibit ventricular dyssynchrony. Both standard echocardiography and TDI are necessary to describe the entire spectrum of mechanical abnormalities due to dyssynchrony.

[1]  Massimo Santini,et al.  Doppler myocardial imaging to evaluate the effectiveness of pacing sites in patients receiving biventricular pacing. , 2002, Journal of the American College of Cardiology.

[2]  P. Denes,et al.  Sequence and Timing of Ventricular Wall Motion in Patients with Bundle Branch Block: Assessment by Radionuclide Cineangiography , 1982, Circulation.

[3]  P. Samet,et al.  Significance of His and Left Bundle Recordings from the Left Heart in Man , 1970, Circulation.

[4]  E. McVeigh,et al.  Effects of single- and biventricular pacing on temporal and spatial dynamics of ventricular contraction. , 2002, American journal of physiology. Heart and circulatory physiology.

[5]  D. Cannom,et al.  Atrioventricular Conduction System in Left Bundle‐Branch Block with Normal QRS Axis , 1972, Circulation.

[6]  J. Blanc,et al.  Evaluation of different ventricular pacing sites in patients with severe heart failure: results of an acute hemodynamic study. , 1997, Circulation.

[7]  H Le Breton,et al.  Acute hemodynamic effects of biventricular DDD pacing in patients with end-stage heart failure. , 1998, Journal of the American College of Cardiology.

[8]  Andrew P. Kramer,et al.  Effect of pacing chamber and atrioventricular delay on acute systolic function of paced patients with congestive heart failure. The Pacing Therapies for Congestive Heart Failure Study Group. The Guidant Congestive Heart Failure Research Group. , 1999, Circulation.

[9]  E. McVeigh,et al.  Mapping propagation of mechanical activation in the paced heart with MRI tagging. , 1999, The American journal of physiology.

[10]  Cardiac resynchronization therapy into the next decade: from the past to morbidity/mortality trials , 2002 .

[11]  Mark E. Josephson,et al.  Clinical cardiac electrophysiology ; techniques and interpretations , 2001 .

[12]  D. Chaleil,et al.  Echocardiographic Assessment of the Interventricular Delay of Activation and Correlation to the QRS Width in Dilated Cardiomyopathy , 2001, Pacing and clinical electrophysiology : PACE.

[13]  F W Prinzen,et al.  Mapping of regional myocardial strain and work during ventricular pacing: experimental study using magnetic resonance imaging tagging. , 1999, Journal of the American College of Cardiology.

[14]  Paolo Rizzon,et al.  Clinical Application of Echocardiographic Findings Cardiac Resynchronization Therapy Tailored by Echocardiographic Evaluation of Ventricular Asynchrony , 2016 .

[15]  I. McDonald.  Echocardiographic Demonstration of Abnormal Motion of the Interventricular Septum in Left Bundle Branch Block , 1973, Circulation.

[16]  Milton Packer,et al.  Cardiac resynchronization in chronic heart failure. , 2002, The New England journal of medicine.

[17]  W. Braham,et al.  Cardiac Resynchronization in Chronic Heart Failure , 2002 .

[18]  G. Breithardt,et al.  Left Bundle Branch Block in Patients With and Without Cardiomyopathy , 1978 .

[19]  R. Pruitt,et al.  Focal Lesions in the Canine Bundle of His: THEIR EFFECT ON VENTRICULAR EXCITATION , 1972, Circulation research.

[20]  P. Spiller,et al.  Cardiomyopathy and Myocardial Biopsy , 1978, Springer Berlin Heidelberg.

[21]  J. Sanderson,et al.  Fragile left atrial thrombus successfully treated with anticoagulants , 2003, Heart.

[22]  Chu-Pak Lau,et al.  Tissue Doppler Echocardiographic Evidence of Reverse Remodeling and Improved Synchronicity by Simultaneously Delaying Regional Contraction After Biventricular Pacing Therapy in Heart Failure , 2002, Circulation.

[23]  Jeroen J. Bax,et al.  Usefulness of myocardial tissue Doppler echocardiography to evaluate left ventricular dyssynchrony before and after biventricular pacing in patients with idiopathic dilated cardiomyopathy. , 2003, The American journal of cardiology.

[24]  D. Kass,et al.  Retiming the failing heart: principles and current clinical status of cardiac resynchronization. , 2002, Journal of the American College of Cardiology.

[25]  P Trambaiolo,et al.  Doppler myocardial imaging in patients with heart failure receiving biventricular pacing treatment. , 2001, American heart journal.

[26]  J. Daubert,et al.  Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. , 2001, The New England journal of medicine.

[27]  Andrew P. Kramer,et al.  Predictors of systolic augmentation from left ventricular preexcitation in patients with dilated cardiomyopathy and intraventricular conduction delay. , 2000, Circulation.

[28]  G R Sutherland,et al.  Regional myocardial function--a new approach. , 2000, European heart journal.

[29]  M. Josephson,et al.  Endocardial activation of left bundle branch block. , 1984, Circulation.

[30]  P. Kelkar,et al.  Intraventricular conduction disturbances. , 1996, The Journal of the Association of Physicians of India.

[31]  Peter Søgaard,et al.  Tissue Doppler imaging predicts improved systolic performance and reversed left ventricular remodeling during long-term cardiac resynchronization therapy. , 2002, Journal of the American College of Cardiology.

[32]  C. Grines,et al.  Functional abnormalities in isolated left bundle branch block. The effect of interventricular asynchrony. , 1989, Circulation.

[33]  K. Rosen,et al.  Bundle Branch and Ventricular Activation in Man: A Study Using Catheter Recordings of Left and Right Bundle Branch Potentials , 1971, Circulation.

[34]  P. Alboni.  Intraventricular Conduction Disturbances , 1981, Developments in Cardiovascular Medicine.

[35]  A. Lazarus,et al.  Echocardiographic Modeling of Cardiac Dyssynchrony Before and During Multisite Stimulation: A Prospective Study , 2003, Pacing and clinical electrophysiology : PACE.