Echocardiographic Assessment of Ventricular Asynchrony in Dilated Cardiomyopathy and Congenital Heart Disease: Tools and Hopes

Dilated Cardiomyopathy and Myocarditis

“…With ventricular dyssynchrony, the end result is reduced cardiac efficiency and stroke volume. Pacemaker therapies with CRT have been shown to reduce morbidity and mortality in selected adults with heart failure [75][76][77][78]. Echocardiography can be used to guide patient selection and pacing parameters in CRT, although there is no consensus on the best parameters and measures to predict response or follow patients undergoing CRT.…”

“…This is determined using parasternal short-axis M-mode by measuring the time from the maximal posterior displacement of the anterior septum to the maximum thickening of the posterior wall, with >130 ms being significant in adults [75,77,79]. 2 LV pre-ejection interval.…”

“…Methods using strain rate imaging (measuring the rate of regional myocardial deformation) can be used to determine true regional myocardial shortening. Delayed longitudinal contraction (postsystolic shortening) can be measured in this way [75].…”

“…This is measured by transmitral pulsedwave Doppler from onset of mitral inflow (E-wave) to end of atrial contraction (A-wave) and is used as a measure of atrioventricular (AV) synchrony. In adults, an LV filling time of <40% of the cardiac cycle (RR interval) is evidence of AV dyssynchrony [75,78], although no such parameters currently exist for children. These parameters are also used to optimize pacemaker settings in heart failure patients.…”

Sudden death prophylaxis in heart failure

“…In patients with an EF ≤ 35% despite optimal pharmacotherapy, we recommend the quantification of LV mechanical dyssynchrony by echocardiography as a first-line tool rather than measurement of the QRS complex duration, which does not reliably detect and predict the presence and degree of dyssynchrony [35][36][37][38][39][40].…”