Echocardiographic Evaluation of Cardiac Dyssynchrony in Patients with Congestive Heart Failure

• Published in: Journal of Huazhong University of Science and Technology. Medical sciences Vol. 36; no. 3; pp. 434 - 441
• Main Author: 秦川 张丽 章子铭 王斌 叶舟 王勇 Navin C.Nanda 谢明星
• Format: Journal Article
• Language: English
• Published: Wuhan Huazhong University of Science and Technology 01.06.2016; Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China; Department of Ultrasound, Central Hospital of Karamay, Karamay 834000, China%Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China%Department of Ultrasound, Central Hospital of Karamay, Karamay 834000, China%Heart Station/Echocardiography Laboratories, The University of Alabama at Birmingham, Alabama 35233, USA
• Subjects: Adult; Aged; Arrhythmias, Cardiac - diagnostic imaging; Arrhythmias, Cardiac - physiopathology; Arrhythmias, Cardiac - therapy; Cardiac Resynchronization Therapy - methods; Case-Control Studies; CHF; Diastole; Echocardiography; Female; Heart - diagnostic imaging; Heart - physiopathology; Heart Failure - diagnostic imaging; Heart Failure - physiopathology; Heart Failure - therapy; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Stroke Volume; Systole; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology; Ventricular Dysfunction, Left - therapy; Ventricular Remodeling; 充血性心力衰竭; 再同步; 心脏; 患者; 时间比例; 评价; 超声心动图; congestive heart failure; cardiac dyssynchrony; left ventricular function; echocardiography
• ISSN: 1672-0733; 1993-1352; 1993-1352
• DOI: 10.1007/s11596-016-1605-8

The present study investigated the application of echocardiography to evaluation of cardiac dyssynchrony in patients with congestive heart failure（CHF）. A total of 348 consecutive CHF patients who were admitted for cardiac resynchronization（CRT） and presented with low ejection fraction（EF） and wide QRS duration were enrolled in this study, along with 388 healthy individuals. Dyssynchrony was assessed based on filling time ratio（FT/RR）, left ventricular pre-ejection delay（PED）, interventricular mechanical delay（IVMD）, longitudinal opposing wall delay（LOWD） and radial septal to posterior wall delay（RSPWD）. Response to CRT was defined as a ≥15% increase in EF. The results showed that FT/RR was decreased while PED, IVMD, LOWD and RSPWD were increased in the CHF group compared with the control group（P〈0.01）. In the CHF group, FT/RR was negatively correlated with the QRS duration, LV end-diastolic diameter（LVESd）, LV end-diastolic volume（LVEDV） and LV end-systolic volume（LVESV）（P〈0.01）, but positively with the LVEF（P〈0.01）. Additionally, PED, IVMD, LOWD and RSPWD were positively correlated with the QRS duration, LVESd, LVEDV and LVESV（P〈0.01）, but negatively with the LVEF（P〈0.01）. The CHF group was divided into three subgroups according to the varying degrees of LVEF. FT/RR decreased successively from the LVEF-1 group to the LVEF-2 group to the LVEF-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order（P〈0.01）. The CHF group was divided into three subgroups according to the varying degrees of QRS duration, and FT/RR decreased successively in a sequence from the QRS-1 group to the QRS-2 group to the QRS-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order（P〈0.01）. Speckle tracking radial dyssynchrony ≥130 ms was predictive of an EF response in patients in QRS-1 group（78% sensitivity, 83% specificity）, those in QRS-2 group（83% sensitivity, 77% specificity） and in QRS-3 group（89% sensitivity, 79% specificity）. In conclusion, echocardiography is a convenient and sensitive method for evaluating cardiac dyssynchrony in patients with CHF.