Systolic and Diastolic Dyssynchrony in Patients With Diastolic Heart Failure and the Effect of Medical Therapy

Wang, Jianwen; Kurrelmeyer, Karla M.; Torre‐Amione, Guillermo; Nagueh, Sherif F.

doi:10.1016/j.jacc.2006.10.023

Cited by 158 publications

(171 citation statements)

References 30 publications

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“…chronotropic incompetence) and attenuated exercise-mediated vasodilatation being documented in several studies [15,16,18,41,42,[44][45][46][47]50,64,[92][93][94][95]. Recent studies have also reported increased prevalence of diastolic dyssynchrony in patients with HFpEF [96][97][98]. The exact role of diastolic dyssynchrony in the pathophysiology of the disease and its relevance to exercise intolerance is not fully understood and warrants further studies.…”

Section: Global Cardiovascular Reserve Dysfunctionmentioning

confidence: 99%

Heart Failure with Preserved Ejection Fraction

Čulić

2017

N Engl J Med

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Heart failure with preserved ejection fraction (HFpEF) has recently emerged as a major cause of cardiovascular morbidity and mortality. Contrary to initial beliefs, HFpEF is now known to be as common as heart failure with reduced ejection fraction (HFrEF) and carries an unacceptably high mortality rate. With a prevalence that has been steadily rising over the past two decades, it is very likely that HFpEF will represent the dominant heart failure phenotype over the coming few years. The scarcity of trials in this semi-discrete form of heart failure and lack of unified enrolment criteria in the studies conducted to date might have contributed to the current absence of specific therapies. Understanding the epidemiological, pathophysiological and molecular differences (and similarities) between these two forms of heart failure is cornerstone to the development of targeted therapies. Carefully designed studies that adhere to unified diagnostic criteria with the recruitment of appropriate controls and adoption of practical end-points are urgently needed to help identify effective treatment strategies.

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Section: Global Cardiovascular Reserve Dysfunctionmentioning

confidence: 99%

Heart Failure with Preserved Ejection Fraction

Čulić

2017

N Engl J Med

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“…This issue is worthy of interrogation in view of the current endeavor made to reveal the precise mechanisms of the LV diastolic asynchrony development. 8 LVSIdia was shown to vary by age; the more advanced age, the more increase in LVSIdia. This was further confirmed by multivariate analysis adjusting for LVEF, LV mass/Ht 2.7 , and QRS duration.…”

Section: Diastolic LV Synchrony Indexesmentioning

confidence: 90%

“…The effect of LV mass increment on LV diastolic asynchrony is easily expected to be enhanced in the setting of hypertension, aortic stenosis, or heart failure, as demonstrated by Wang et al where correlation coefficient between LV mass index and diastolic time delay was 0.79 as contrasted with that in our normal population (r = 0.15-0.22). 8 They also suggested the possible reduction in LVSIdia with optimal medical therapy in patients with heart failure. Since the ''pathologic'' myocardial hypertrophy induced by hypertension or aortic stenosis can be revered with antihypertensive medication or aortic valve replacement, respectively, the reversibility of LV diastolic asynchrony by medical or surgical treatment is of clinical relevance.…”

Section: Diastolic LV Synchrony Indexesmentioning

confidence: 99%

“…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.…”

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confidence: 99%

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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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“…24,25 LV dyssynchrony is associated with the development of LV remodeling after acute myocardial infarction 26 and increases the risk of new-onset HF in patients with hypertension. 27 The effects of medical treatment on dyssynchrony in patients with CAD, 28 hypertrophic cardiomyopahthy, 29 dilated cadiomyopathy 30 and HF [30][31][32] have been reported, but patients with hypertension and a structurally normal heart have not been evaluated. Our trial demonstrated the benefit of chronic antihypertensive treatment on dyssynchrony in patients with early stage hypertension.…”

Section: Discussionmentioning

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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Systolic and Diastolic Dyssynchrony in Patients With Diastolic Heart Failure and the Effect of Medical Therapy

Abstract: Systolic dyssynchrony occurs in 33% of DHF patients, and diastolic dyssynchrony occurs in 58%. Medical therapy results in significant shortening of the diastolic intraventricular time delay which is closely related to improvement in LV relaxation.

Cited by 158 publications

References 30 publications

Heart Failure with Preserved Ejection Fraction

Heart Failure with Preserved Ejection Fraction

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

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

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