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CLINICAL RESEARCH: NORMAL QRS DURATION AND RESYNCHRONIZATION

Mechanical Dyssynchrony Assessed by Tissue Doppler Imaging Is a Powerful Predictor of Mortality in Congestive Heart Failure With Normal QRS Duration

Goo-Yeong Cho, MD^_*,_*, Jae-Kwan Song, MD, FACC, Woo-Jung Park, MD^_*, Sung-Woo Han, MD^_*, Seung-Hyuk Choi, MD^_*, Young-Cheoul Doo, MD^_*, Dong-Jin Oh, MD^_* and Yung Lee, MD^_*

^_* Division of Cardiology, Hangang Sacred Heart Hospital, University of Hallym, Seoul, Korea
Division of Cardiology, Asan Medical Center, University of Ulsan, Seoul, Korea

Manuscript received August 9, 2004; revised manuscript received October 25, 2004, accepted November 1, 2004.

^_* Reprint requests and correspondence: Dr. Goo-Yeong Cho, Hangang Sacred Heart Hospital, University of Hallym, Yeongdeungpo-Dong Yeongdeungpo-Ku 94-200, Seoul 150-030, South Korea (Email: cardioch{at}medimail.co.kr).

OBJECTIVES: We sought to test whether the mechanical dyssynchrony assessed by tissue Doppler imaging (TDI) is a predictor of cardiac events in patients with congestive heart failure (CHF) and QRS duration 120 ms.

BACKGROUND: The prevalence and prognostic value of mechanical dyssynchrony in patients with CHF and normal QRS duration have not been well clarified.

METHODS: A total of 106 patients (age 63 ± 11 years) with CHF and ejection fraction (EF) <35% were followed serially; TDI was performed using four basal and four mid-left ventricular segments to assess the time to peak systolic point from R-wave on electrocardiogram (Ts). The standard deviation of Ts (Ts-SD) and the maximal temporal difference of Ts (Ts-diff) of eight segments were used as an indicator of mechanical dyssynchrony. Clinical events included readmission due to worsening of CHF, cardiac transplantation, and death.

RESULTS: After 17 ± 11 months of follow-up, the clinical event rate was 33% including all-cause mortality of 19%. Prolonged Ts-SD (>37 ms) and Ts-diff (>91 ms) were associated with a significant increase in all clinical events. By multivariate analysis, Ts-diff (>91 ms) was an independent risk factor of clinical events and mortality regardless of age, EF, QRS duration, and use of beta-blocking agents. Mean event-free survival was 16.3 months (95% confidence interval [CI] 11.9 to 20.7) in patients with Ts-diff >91 ms and 31.6 months (95% CI 28.0 to 35.1) in those with Ts-diff 91 ms, respectively (p < 0.001).

CONCLUSIONS: Myocardial dyssynchrony assessed by TDI is a powerful predictor of clinical events in CHF with normal QRS.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   CHF = congestive heart failure   CRT = cardiac resynchronization therapy   ECG = electrocardiography/electrocardiogram   EF = ejection fraction   LV = left ventricle/ventricular   ROC = receiver-operating characteristic   TDI = tissue Doppler imaging   Te = time to early peak diastolic velocity from R-wave on electrocardiogram   Ts = time to peak systolic point from R-wave on electrocardiogram   Ts-diff = maximal temporal difference of Ts   Ts-SD = standard deviation of Ts

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