Diastolic and Systolic Asynchrony in Patients With Diastolic Heart Failure

Yu, Cheuk‐Man; Zhang, Qing; Yip, Gabriel Wai-Kwok; Lee, Alex; Kum, Leo C.C.; Lam, Yat‐Yin; Fung, Jeffrey Wing‐Hong

doi:10.1016/j.jacc.2006.10.022

Cited by 165 publications

(159 citation statements)

References 40 publications

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“…For the assessment of systolic synchrony, the standard deviation of Ts (Ts-SD) of all 12 LV segments and the maximal difference in Ts (Ts-diff) between any 2 of the 12 LV segments were calculated. 13,14 For evaluation of diastolic synchrony, the standard deviation of Te (Te-SD) of all 12 LV segments and the maximal difference in Te (Te-diff) were measured. 13,14 To assess global cardiac function, the mean myocardial systolic (Sm) and early diastolic (Em) velocities of 12 segments were calculated.…”

Section: Echocardiography and Tdimentioning

confidence: 99%

“…13,14 For evaluation of diastolic synchrony, the standard deviation of Te (Te-SD) of all 12 LV segments and the maximal difference in Te (Te-diff) were measured. 13,14 To assess global cardiac function, the mean myocardial systolic (Sm) and early diastolic (Em) velocities of 12 segments were calculated. The intraobserver's correlationsfor these variables were compared in 20 consecutive measurements and showed satisfactory reproducibility (intraobserver variability of Ts-SD, Te-SD, Ts-dif, Sm, and Em was 6.85%, 6.46%, 5.65%, 4.89%, and 4.68%, respectively).…”

Section: Echocardiography and Tdimentioning

confidence: 99%

“…Tissue Doppler imaging (TDI), a relatively new technology, can be used to evaluate global cardiac function 12 and ventricular synchrony. 13,14 Using standard 2D echocardiography (2DE) and TDI, this prospective randomized control study aimed to systematically evaluate the effects of RVOT and RVA pacing on left ventricular synchrony, cardiac function, and remodeling in patients with normal cardiac function.…”

Section: Introductionmentioning

confidence: 99%

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Is Right Ventricular Outflow Tract Pacing Superior to Right Ventricular Apex Pacing in Patients with Normal Cardiac Function?

Gong

Pan

et al. 2009

Clinical Cardiology

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Background: Whether right ventricular outflow tract (RVOT) pacing is superior to right ventricular apex (RVA) pacing in terms of ventricular synchrony, cardiac function, and remodeling in patients with normal cardiac function is still unknown. Hypothesis: Right ventricular outflow tract pacing is superior to RVA pacing in patients with normal cardiac function. Methods: A total of 96 consecutive patients with high or third-degree atrial ventricular block were enrolled and randomized into 2 groups: RVOT pacing group (n = 48) and RVA pacing group (n = 48). Tissue Doppler imaging (TDI) and 2D echocardiography were performed to study left ventricular (LV) systolic and diastolic synchrony, LV volumes, and function. Results: There were no significant differences in baseline characteristics between the 2 groups. Left ventricular systolic asynchrony is more severe in the RVA pacing group than in the RVOT pacing group (P < 0.05), while diastolic synchrony is not significantly (NS) different between the 2 groups after pacing. There were no significant differences with respect to the mean myocardial systolic (Sm) and early diastolic velocities (Em), LV ejection fraction, LV end-diastolic and systolic volume in the 2 groups at 12 months of follow-up (all NS). Conclusions: Although RVOT pacing caused more synchronous LV contraction compared with RVA pacing, it had no benefit over RVA pacing in aspect of preventing cardiac remodeling and preserving LV systolic function after 12 months of pacing in patients with normal cardiac function.

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Section: Echocardiography and Tdimentioning

confidence: 99%

Section: Echocardiography and Tdimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Is Right Ventricular Outflow Tract Pacing Superior to Right Ventricular Apex Pacing in Patients with Normal Cardiac Function?

Gong

Pan

et al. 2009

Clinical Cardiology

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“…19,20 A Ts-SD12 X33 or Ts-Max X100 ms was regarded as the presence of LV systolic dyssynchrony. 21 (2) exceeding aortic valve closure on the overall 12 LV basal and midsegments (oExcT) was measured. 22 (4) Each parameter was obtained from three consecutive cardiac cycles and was only included in the algorithm for o10% beat-to-beat variation to improve reproducibility and accuracy.…”

Section: Echocardiographic Assessmentmentioning

confidence: 99%

Impact of antihypertensive treatment on left ventricular systolic dyssynchrony in treatment-naïve hypertensive patients

et al. 2012

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Dyssynchrony is common in asymptomatic patients with hypertension. We sought to investigate the impact of antihypertensive treatment on dyssynchrony in patients with hypertension. A total of sixty patients who had uncomplicated hypertension that had never been treated (treatment-naïve hypertensive patients) underwent echocardiographic evaluations of left ventricular (LV) dyssynchrony at baseline and after a 6-month treatment with antihypertensive drugs. The measured parameters were as follows:(1) the s.d. of 12 LV-segment time-to-peak systolic velocities (Ts-SD12), and (2) the maximal difference between peak systolic velocities of any 2 of the 12 segments (Ts-Max). Patients with Ts-SD12 X33 ms or Ts-Max X100 ms were regarded as having LV systolic dyssynchrony. Patients with systolic dyssynchrony (group 1, n¼29) and without systolic dyssynchrony (group 2, n¼31) were compared. Among the patients in group 1, antihypertensive treatment significantly improved LV systolic dyssynchrony (DTs-SD12, À13.1 ms; Po0.001 and DTs-Max, À34.0 ms; P¼0.003), whereas it did not demonstrate additional benefit among group 2 patients. The change in LV systolic dyssynchrony was significantly associated with changes in the mean annulus E¢ velocity, mean annulus S¢ velocity and mean annulus E¢/A¢ ratio, but not with changes in blood pressure and LV mass index. It is likely that chronic antihypertensive treatment could reverse the LV systolic dyssynchrony and simultaneously improve subclinical systolic and diastolic function in patients with hypertension and LV systolic dyssynchrony. INTRODUCTIONIt is well known that left ventricular (LV) systolic or diastolic dyssynchrony is common in patients with heart failure (HF) and a normal QRS duration. 1 There has been increased recognition that LV dyssynchrony also exists in patients without HF but with other cardiac diseases, including hypertension, 2 coronary artery disease (CAD) 3 and cardiomyopathy. 4,5 Dyssynchrony has been measured using a variety of echocardiographic parameters based on different imaging techniques, 6 including pulsed-wave tissue Doppler imaging (TDI), colorcoded TDI, tissue tracking, displacement mapping, strain and strain rate imaging, and tissue synchronization imaging. TDI is the most extensively tested method.Hypertension is a major risk factor for LV hypertrophy and HF. Epidemiological studies have demonstrated that hypertension accounts for 50% of patients with HF. 7 Recently, it was demonstrated that LV systolic dyssynchrony was present in 24% of asymptomatic patients with hypertension. 2 Moreover, on the basis of results from the previous study, 8 the proportion of treatment-naïve hypertensives with LV systolic dyssynchrony was found to be 44.5%.

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“…Semiautomatic tracking of the region of interest was performed to maintain the sample volume in the region of interest throughout the cardiac cycle if the velocity signal is not obvious. The time to peak myocardial systolic velocity during ejection phase (Ts) and the time to peak myocardial early diastolic velocity (Te) were measured with reference to QRS complex 3,6,7,8 (Figure). Motion of the anterior mitral leaflet was tracked using the color M-mode TDI technique to determine cardiac time intervals.…”

mentioning

confidence: 99%

Effects of the Aging Process on Left Ventricular Systolic and Diastolic Synchronicity Indexes: Insights From 160 “Completely” Healthy Volunteers

Kim

Sohn

Chang

et al. 2010

Clinical Cardiology

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Background: Growing attempt to use left ventricular (LV) systolic (LVSIsys) and diastolic (LVSIdia) synchronicity indexes in the process of selecting potential responders to cardiac resynchronization therapy has created a need for normative reference values. Hypothesis: This study sought: (1) to determine normal reference ranges for LVSIsys and LVSIdia, and (2) to assess their relationships to age and conventional parameters reflecting LV systolic and diastolic functions. Methods: We recruited 160 healthy volunteers (104 men) free of any systemic or cardiovascular disease. Maximal difference and standard deviation of time to peak systolic and peak early diastolic myocardial velocities for LVSIsys and LVSIdia were measured using 6 and 12 segment models. Results: Normal ranges for LVSIsys and LVSIdia obtained in this study were slightly higher than previously reported. The normal aging process did not significantly change LVSIsys, whereas LVSIdia progressively and consistently increased with age. Significant correlations were observed between LVSIdia and parameters representing LV diastolic function, that is, early mitral inflow velocity and its deceleration time, and early mitral annulus velocity. A physiologic increase in LV mass/Ht 2.7 showed a weak, but significant correlation with LVSIdia (r = 0.15-0.22), but not with LVSIsys. On multivariate analysis, an age-dependent increase in LVSIdia was confirmed. Conclusions:In this study, we propose age-specific reference ranges for LVSIsys and LVSIdia. LVSIsys remains stable throughout age groups, whereas LVSIdia progressively increases with age. We believe that the reference values provided here will be useful for defining abnormal LV synchronous contraction and relaxation.

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Diastolic and Systolic Asynchrony in Patients With Diastolic Heart Failure

Abstract: Diastolic and/or systolic asynchrony was common in 61% of DHF patients despite narrow QRS complex. The presence of asynchrony was not related to myocardial systolic or diastolic function. Systolic and diastolic asynchrony were not tightly coupled, implying distinct mechanisms.

Cited by 165 publications

References 40 publications

Is Right Ventricular Outflow Tract Pacing Superior to Right Ventricular Apex Pacing in Patients with Normal Cardiac Function?

Is Right Ventricular Outflow Tract Pacing Superior to Right Ventricular Apex Pacing in Patients with Normal Cardiac Function?

Impact of antihypertensive treatment on left ventricular systolic dyssynchrony in treatment-naïve hypertensive patients

Effects of the Aging Process on Left Ventricular Systolic and Diastolic Synchronicity Indexes: Insights From 160 “Completely” Healthy Volunteers

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