Relationship of echocardiographic left ventricular dyssynchrony with QRS width on surface electrocardiogram in patients with systolic heart failure: An observational study

Shaik, Shabbir Ali; Oruganti, Sai Satish

doi:10.1016/j.ihj.2021.08.004

Cited by 4 publications

(1 citation statement)

References 6 publications

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“…In biventricular hearts with acquired heart diseases, QRS duration correlates with markers of ventricular dyssynchrony, dilation, and heart failure. 35,36 QRS duration has also been identified as a prognostic indicator in CHD such as tetralogy of Fallot; although, recent studies have shown that its effect may not be independent of LV dysfunction. 37 Similar data in the Fontan population are limited.…”

Section: Discussionmentioning

confidence: 99%

Ventricular Dyssynchrony Late after the Fontan Operation is Associated with Decreased Survival and the Presence of Arrhythmias

Gearhart

Bassi

Rathod

et al. 2023

Preprint

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BackgroundVentricular dyssynchrony and its relationship to clinical outcomes is not well characterized in patients following Fontan palliation.MethodsSingle-center retrospective analysis of cardiac magnetic resonance (CMR) imaging of patients with a Fontan circulation and age-matched healthy comparison cohort as controls. Feature tracking was performed on all slices of a ventricular short-axis cine stack. Circumferential and radial strain, strain rate, and displacement were measured; and multiple dyssynchrony metrics were calculated based on timing of these measurements (including standard deviation of time-to-peak, maximum opposing wall delay, and maximum base-to-apex delay). Primary endpoint was a composite measure including time to death or heart transplant listing (D/HTx); secondary outcomes were the presence of atrial or ventricular arrhythmias.ResultsA total of 503 cases (15y; IQR 10, 21) and 42 controls (16y; IQR 11, 20) were analyzed. Compared to controls, Fontan patients had increased dyssynchrony metrics, longer QRS duration, larger ventricular volumes, and worse systolic function. Dyssynchrony metrics were higher in patients with right ventricular (RV) or mixed morphology compared to those with LV morphology. At median follow-up of 4.3 years, 11% had D/HTx, 7% ventricular arrhythmia, and 38% atrial arrhythmia. Multiple risk factors for D/HTx were identified, including RV morphology, ventricular dilation, dysfunction, QRS prolongation, and dyssynchrony. Ventricular dilation and RV morphology were independently associated with D/HTx; ventricular dilation and global circumferential strain were independently associated with ventricular and atrial arrhythmias.ConclusionsMechanical dyssynchrony is highly prevalent in functional single ventricles palliated to the Fontan circulation and is more pronounced in hearts with RV or mixed ventricular morphology compared to those with LV morphology. Dyssynchrony is associated with death or need for heart transplantation and cardiac arrhythmias. These data add to the growing understanding regarding factors that can be used to risk-stratify patients with the Fontan circulation.

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Section: Discussionmentioning

confidence: 99%

Ventricular Dyssynchrony Late after the Fontan Operation is Associated with Decreased Survival and the Presence of Arrhythmias

Gearhart

Bassi

Rathod

et al. 2023

Preprint

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Right ventricular dyssynchrony for the prediction of prognosis in patients with systemic lupus erythematosus-aaociated pulmonary arterial hypertension: a study with two-dimensional speckle tracking

Tan,

Deng,

Lan

et al. 2024

Int J Cardiovasc Imaging

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Pulmonary arterial hypertension (PAH) is a common complication of systemic lupus erythematosus (SLE), and PAH can cause right ventricle (RV) remodel and dyssynchrony. The aim of this study was to explore the value of RV dyssynchrony in predicting adverse clinical events in patients with systemic lupus erythematosus-aaociated pulmonary arterial hypertension (SLE-PAH) using two-dimensional speckle tracking echocardiography (2D-STE). MethodsA total of 53 patients with SLE-PAH were assigned to an adverse clinical event group and a non-adverse clinical event group. The dyssynchrony of the RV (RV-SD6) was evaluated by 2D-STE. The clinical data of all participants were collected, and routine cardiac function parameters were measured by twodimensional echocardiography, and analyzed for their correlation with RV-SD6. The predictive value of RV-SD6 in clinical adverse event was evaluated. ResultsRV-SD6 was negatively correlated with RV-FLS, RV-FAC, and TAPSE (r=-0.788, r=-0.363 and r=-0.325, respectively, all P < 0.01), while the correlation with RV-FLS was the strongest. linear regression analysis showed that RV-FLS was an independent risk factor for RV-SD6 (β=-1.40, 95% CI -1.65 ~ -1.14, P < 0.001). Cox regression analysis showed that RV-SD6 was independently associated with clinical adverse events (HR = 1.03, 95% CI 1 ~ 1.06, P < 0.05). RV-SD6 was highly discriminative in predicting clinical adverse events (AUC = 0.764), at a cutoff of 51.10 ms with a sensitivity of 83.3% and speci city of 68.3%. ConclusionRV-FLS was negatively correlated with RV-SD6 and was an independent risk factor for it. RV-SD6 can serve as an indicator for predicting the occurrence of adverse clinical events in SLE-PAH patients, with high sensitivity and speci city.

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Ventricular dyssynchrony late after the Fontan operation is associated with decreased survival

Gearhart,

Bassi,

Rathod

et al. 2023

Journal of Cardiovascular Magnetic Resonance

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Background Ventricular dyssynchrony and its relationship to clinical outcomes is not well characterized in patients following Fontan palliation. Methods Single-center retrospective analysis of cardiac magnetic resonance (CMR) imaging of patients with a Fontan circulation and an age-matched healthy comparison cohort as controls. Feature tracking was performed on all slices of a ventricular short-axis cine stack. Circumferential and radial strain, strain rate, and displacement were measured; and multiple dyssynchrony metrics were calculated based on timing of these measurements (including standard deviation of time-to-peak, maximum opposing wall delay, and maximum base-to-apex delay). Primary endpoint was a composite measure including time to death, heart transplant or heart transplant listing (D/HTx). Results A total of 503 cases (15 y; IQR 10, 21) and 42 controls (16 y; IQR 11, 20) were analyzed. Compared to controls, Fontan patients had increased dyssynchrony metrics, longer QRS duration, larger ventricular volumes, and worse systolic function. Dyssynchrony metrics were higher in patients with right ventricular (RV) or mixed morphology compared to those with LV morphology. At median follow-up of 4.3 years, 11% had D/HTx. Multiple risk factors for D/HTx were identified, including RV morphology, ventricular dilation, dysfunction, QRS prolongation, and dyssynchrony. Ventricular dilation and RV morphology were independently associated with D/HTx. Conclusions Compared to control LVs, single right and mixed morphology ventricles in the Fontan circulation exhibit a higher degree of mechanical dyssynchrony as evaluated by CMR-FT. Dyssynchrony indices correlate with ventricular size and function and are associated with death or need for heart transplantation. These data add to the growing understanding regarding factors that can be used to risk-stratify patients with the Fontan circulation.

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Relationship of echocardiographic left ventricular dyssynchrony with QRS width on surface electrocardiogram in patients with systolic heart failure: An observational study

Cited by 4 publications

References 6 publications

Ventricular Dyssynchrony Late after the Fontan Operation is Associated with Decreased Survival and the Presence of Arrhythmias

Ventricular Dyssynchrony Late after the Fontan Operation is Associated with Decreased Survival and the Presence of Arrhythmias

Right ventricular dyssynchrony for the prediction of prognosis in patients with systemic lupus erythematosus-aaociated pulmonary arterial hypertension: a study with two-dimensional speckle tracking

Ventricular dyssynchrony late after the Fontan operation is associated with decreased survival

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