CARDIOVASCULAR MEDICINE

High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration

C-M Yu, H Lin, Q Zhang, J E Sanderson

Division of Cardiology, Department of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong

Correspondence to:
Correspondence to:
Dr C-M Yu, Department of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong;
cmyua{at}hkucc.hku.hk

Objective: To study the possible occurrence of left ventricular (LV) systolic and diastolic asynchrony in patients with systolic heart failure (HF) and narrow QRS complexes.

Design: Prospective study.

Setting: University teaching hospital.

Patients: 200 subjects were studied by echocardiography. 67 patients had HF and narrow QRS complexes ( 120 ms), 45 patients had HF and wide QRS complexes (> 120 ms), and 88 served as normal controls.

Interventions: Echocardiography with tissue Doppler imaging was performed using a six basal, six mid-segmental model.

Main outcome measures: Severity and prevalence of systolic and diastolic asynchrony, as assessed by the maximal difference in time to peak myocardial systolic contraction (T_S) and early diastolic relaxation (T_E), and the standard deviation of T_S (T_S-SD) and of T_E (T_E-SD) of the 12 LV segments.

Results: The mean (SD) maximal difference in T_S (controls 53 (23) ms v narrow QRS 107 (54) ms v wide QRS 130 (51) ms, both p < 0.001 v controls) and in T_S-SD (controls 17.0 (7.8) ms v narrow QRS 33.8 (16.9) ms v wide QRS 42.0 (16.5) ms, both p < 0.001 v controls) was prolonged in the narrow QRS group compared with normal controls. Similarly, the maximal difference in T_E (controls 59 (19) ms v narrow QRS 104 (71) ms v wide QRS 148 (87) ms, both p < 0.001 v controls) and in T_E-SD (controls 18.5 (5.8) ms v narrow QRS 33.3 (27.7) ms v wide QRS 48.6 (30.2) ms, both p < 0.001 v controls) was prolonged in the narrow QRS group. The prevalence of systolic and diastolic asynchrony was 51% and 46%, respectively, in the narrow QRS group, and 73% and 69%, respectively, in the wide QRS group. Stepwise multiple regression analysis showed that a low mean myocardial systolic velocity from the six basal LV segments and a large LV end systolic diameter were independent predictors of systolic asynchrony, while a low mean myocardial early diastolic velocity and QRS complex duration were independent predictors of diastolic asynchrony.

Conclusions: LV systolic and diastolic mechanical asynchrony is common in patients with HF with narrow QRS complexes. As QRS complex duration is not a determinant of systolic asynchrony, it implies that assessment of intraventricular synchronicity is probably more important than QRS duration in considering cardiac resynchronisation treatment.

Keywords: echocardiography; heart failure; electrocardiography; asynchrony

Abbreviations: E_M, myocardial early diastolic velocity; HF, heart failure; LV, left ventricular; S_M, myocardial sustained systolic velocity; T_E, time to peak early diastolic velocity; T_E-SD; standard deviation of T_E; T_S, time to peak myocardial sustained systolic velocity; T_S-SD; standard deviation of T_S

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