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KMID : 0374920100310010009
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Inje Medical Journal
2010 Volume.31 No. 1 p.9 ~ p.24
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Comparative study of mechanical dyssynchrony in patients with heart failure with normal subjects
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Jun Hyun-Soo
Park Si-Hyung
Park Jin-Han
Kim Hyun-Joo
Kim Mo-Se
Lee Young-Jin
Kim Dae-Kyeong
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Abstract
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Background and Objectives: Congestive heart failure remains a major and growing public health problem despite recent developing of therapy. Cardiac resynchronization can reduce the LBBB-induced mechanical interventricular dyssynchrony and intraventricular dyssynchrony. QRS duration is useful but is not the sine qua non indicator of mechanical dyssynchrony. The aim of this study was to evaluate mechanical dyssynchrony by using echocardiography in patients with heart failure and compare it with that of normal subjects.
Subjects and Methods: 74 patients were included in this study. They were categorized into three groups. 30 patients served as normal subjects. 29 patients had HF and narrow QRS complexes. 15 patients had heart failure and wide QRS complexes. We assessed the time from the onset of QRS to the onset of the aortic and pulmonary flow using pulsed wave Doppler echocardiography on the apical three-chamber view and parasternal short-axis view, and measured the time from the onset of QRS to the pea(c myocardial velocity using tissue doppler imaging at each basal four segment in the apical two and four-chamber views.
Results: The mean difference between right ventricle and left ventricle was prolonged in the wide QRS group compared with those of narrow QRS group and normal controls.(controls 4.5±11.1㎳, narrow QRS group 13.5±5.0msL, wide QRS group 46.5±20.4㎳) The prevalence of interventricular dyssynchrony was 3.4% in the narrow QRS group, 53.3% in the wide QRS group. Intraventricular delay between septal and lateral wall was prolonged in the narrow and wide QRS group compared with one of normal controls.(controls 18.7±14.0㎳, narrow QRS group 55.6±83.5㎳, wide QRS group 78.2±70.0㎳) The prevalence of intraventricular dyssynchrony was 27.6% in the narrow QRS group, 53.3% in the wide QRS group. Intraventricular delay between anterior and inferior wall was prolonged in the narrow and wide QRS compared with one of normal subjects.(controls 19.2±14.0㎳, narrow QRS group 45.5±50.0㎳, wide QRS group 69.3±51.1㎳) The prevalence of intraventricular dyssynchrony was 27.6% in the narrow QRS group, 33.3% in the wide QRS group.
Conclusion: Wide QRS duration has been mainly used to predict the interventricular and intraventricular dyssynchrony. we can also find the intraventricular dysynchrony even in the patients with HF with narrow QRS complexes. Our results revealed that intraventricular dyssynchronyis may be more related LVEF than QRS duration.
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KEYWORD
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Dyssynchrony, left bundle branch block, Congestive, Heart Failure
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