© 2008 European Society of Cardiology
The effect of pharmacological stress on intraventricular dyssynchrony in left ventricular systolic dysfunction
a Department of Cardiology, University of Hull Kingston-upon-Hull, UK
b University Hospital of Wales Cardiff, UK
* Corresponding author. 36 St Stephens Mansions, Mount Stuart Square, Cardiff, CF10 5LQ, UK. Tel.: +44 2920 493543. E-mail address: diptochatt{at}yahoo.co.uk (S. Chattopadhyay).
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Abstract |
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Background: Cardiac resynchronisation therapy (CRT) improves symptoms and exercise capacity in many patients with heart failure (HF) who have left ventricular systolic dysfunction (LVSD) and markers of dyssynchrony. LV dyssynchrony is conventionally measured at rest but the symptoms of heart failure occur predominantly on exercise. Induction or exacerbation of dyssynchrony during stress might identify additional patients who could benefit from CRT.
Methods and results: Seventy-seven patients (47 with QRSd<120 ms and 30 with QRSd>120 ms) with heart failure due to left ventricular systolic dysfunction and 22 normal subjects underwent dobutamine stress echocardiography using colour tissue Doppler imaging. Left intraventricular dyssynchrony was measured as the standard deviation of the time to peak velocity from the onset of the QRS (Ts-SD) and the difference between the maximum and minimum time to peak velocity (Tscor-diff) in the 12 non-apical segments at rest and during peak stress. Timings were corrected for heart rate. The mean values of these indices increased with stress in both groups of patients but not in control subjects (p < 0.001). The prevalence of conventionally-defined dyssynchrony also increased with stress.
Conclusion: In patients with heart failure, the severity and the prevalence of intraventricular dyssynchrony increase with stress. Whether stress-induced dyssynchrony will identify patients who might benefit from CRT awaits further research.
Key Words: Stress echocardiography • Dyssynchrony • Cardiac resynchronisation therapy • Tissue Doppler imaging
Received July 3, 2007; Revised December 3, 2007; Accepted February 4, 2008
1 Professor John GF Cleland was the Principal Investigator of the CARE-heart failure study and has received funding to attend meetings and honoraria for speaking on aspects of heart failure from Medtronic and Biotronik. No other conflicts of interest.
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