CLINICAL RESEARCH: DYSSYNCHRONY
Dynamic Ventricular Dyssynchrony
An Exercise-Echocardiography Study
Stephane Lafitte, MD, PhD*,b,
Pierre Bordachar, MD*,b,
Marianne Lafitte, MD*,b,
Stephane Garrigue, MD, PhD*,
Sylvain Reuter, MD*,
Patricia Reant, MD*,
Karim Serri, MD*,
Valerie Lebouffos, MD*,
Marianne Berrhouet, MD*,
Pierre Jais, MD, PhD*,
Michel Haissaguerre, MD*,
Jacques Clementy, MD*,
Raymond Roudaut, MD* and
Anthony N. DeMaria, MD ,a,*
* Cardiologic Hospital, Pessac and Bordeaux 2 University, Bordeaux, France
Division of Cardiology, University of California at San Diego, San Diego, California
Manuscript received July 22, 2005;
revised manuscript received November 10, 2005,
accepted November 17, 2005.
* Reprint requests and correspondence: Dr. Anthony N. DeMaria, University of California San Diego, Division of Cardiology, 200 West Arbor Drive, San Diego, California 92103-9000 (Email: ademaria{at}ucsd.edu).
OBJECTIVES: We sought to assess the effects of exercise on ventricular dyssynchrony in patients with normal and depressed left ventricular (LV) function.
BACKGROUND: Asynchronous myocardial contraction adversely influences ventricular function and is associated with a poor prognosis in heart failure. Exercise-induced changes in ventricular dyssynchrony may be an important determinant of dynamic changes in cardiac output and mitral regurgitation.
METHODS: A total of 65 consecutive heart failure patients and 50 matched healthy control patients underwent exercise echocardiography. Conventional and tissue Doppler parameters were measured before and during symptom-limited exercise. Left ventricular dyssynchrony was defined as the standard deviation of 12 LV segmental electromechanical delays. Analysis of the control group allowed delimitation of normal cutoff values.
RESULTS: In patients with normal left ventricular function, exercise did not modify the extent of LV asynchrony. In contrast, in heart failure patients, LV dyssynchrony increased by at least 20% in 34%, remained stable in 37%, and decreased by at least 20% in 29%. Moreover, 26% of heart failure patients had either exercise induction or normalization of ventricular dyssynchrony. A significant association was found between exercise-induced changes in dyssynchrony and the presence of ischemic cardiomyopathy (p < 0.05). Rest-exercise differences in ventricular dyssynchrony were correlated with changes in cardiac output and mitral regurgitation (r = –0.63 and 0.56, respectively).
CONCLUSIONS: In heart failure patients, exercise can alter the magnitude of ventricular dyssynchrony. Some patients have a response to exertion with induction of ventricular dyssynchrony, whereas others show normalization. Changes in ventricular dyssynchrony during exercise correlate with alterations in cardiac output and mitral regurgitation.
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Abbreviations and Acronyms
| | %DLC = extent of myocardium showing delayed longitudinal contraction | | LV = left ventricular | | SD-12 = standard deviation of time to peak systolic velocity of the 12 left ventricular segments | | TO = time to onset of segmental contraction | | TO-6base = maximal difference in time to onset of segmental contraction between any two of six basal left ventricular segments | | TP = time to peak systolic velocity | | TP-6base = maximal difference in time to peak systolic velocity between any two of six basal segments | | TP-sep-lat = difference between time to peak systolic velocity of septobasal and laterobasal segments | | VTI = velocity time integral |
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