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J Am Coll Cardiol, 2002; 40:2022-2030
© 2002 by the American College of Cardiology Foundation
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CLINICAL STUDY

Interventricular and intraventricular dyssynchrony in idiopathic dilated cardiomyopathy

A prognostic study with fourier phase analysis of radionuclide angioscintigraphy

Laurent Fauchier, MD, PhD*, Olivier Marie, MD*, Danielle Casset-Senon, MD{dagger},*, Dominique Babuty, MD, PhD*, Pierre Cosnay, MD* and Jean Paul Fauchier, MD, FACC*

* Services de Cardiologie B et , Centre Hospitalier Universitaire Trousseau, Tours, France
{dagger} Médecine Nucléaire, Centre Hospitalier Universitaire Trousseau, Tours, France

Manuscript received March 27, 2002; revised manuscript received July 17, 2002, accepted August 1, 2002.

* Reprint requests and correspondence: Dr. Laurent Fauchier, Service de Cardiologie B, Centre Hospitalier Universitaire Trousseau, 37044 Tours, France.
lfau{at}med.univ-tours.fr

OBJECTIVES: The study evaluated the prognostic value of interventricular and intraventricular dyssynchrony in idiopathic dilated cardiomyopathy (IDC).

BACKGROUND: Biventricular pacing is an emerging treatment for patients with dilated cardiomyopathy and ventricular dyssynchrony. The prognostic values of interventricular and intraventricular dyssynchrony have not been previously compared.

METHODS: A total of 103 patients with IDC were studied. Left bundle branch block was present in 25% of patients. Equilibrium radionuclide angiography was performed and Fourier phase analyses were examined in both ventricles. Difference between the mean phase of left ventricle (LV) and right ventricle (RV) assessed interventricular dyssynchrony, and standard deviations (SDs) of the mean phase in each ventricle assessed intraventricular dyssynchrony.

RESULTS: The QRS duration was related to both interventricular and intraventricular dyssynchrony. A degradation of the hemodynamic status was associated with an increase in intraventricular dyssynchrony but not in interventricular dyssynchrony. With a follow-up of 27 ± 23 months, 18 patients had a major cardiac event (7 cardiac deaths; 11 worsening, leading to heart transplantation). The SDs of the LV and RV mean phase and QRS duration were predictors of cardiac event (all p < 0.0001), but interventricular dyssynchrony was not. Among 13 univariate predictors of cardiac event, the only independent predictors were an increased SD of LV mean phase (p = 0.0004) and an increased pulmonary capillary wedge pressure (p = 0.009).

CONCLUSIONS: Intraventricular dyssynchrony evaluated with phase analysis of radionuclide angiography is an independent predictor of cardiac event in IDC. The prognosis is related to intraventricular rather than to interventricular dyssynchrony in IDC.

Abbreviations and Acronyms
  BiV
  biventricular pacing
  ECG
  electrocardiogram
  EF
  ejection fraction
  ERNA
  equilibrium radionuclide-gated blood pool angiography
  HF
  heart failure
  IDC
  idiopathic dilated cardiomyopathy
  LBBB
  left bundle branch block
  LV
  left ventricle
  NYHA
  New York Heart Association
  RBBB
  right bundle branch block
  RV
  right ventricle
  SD
  standard deviation




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