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CLINICAL RESEARCH: DIASTOLIC FUNCTION AND RESYNCHRONIZATION

Diastolic Asynchrony Is More Frequent Than Systolic Asynchrony in Dilated Cardiomyopathy and Is Less Improved by Cardiac Resynchronization Therapy

Iris Schuster, MD^_*, Gilbert Habib, MD, FACC^_*,_*, Christophe Jego, MD^_*, Franck Thuny, MD^_*, Jean-François Avierinos, MD^_*, Geneviève Derumeaux, MD, Lionel Beck, MD^_*, Christine Medail, MD^_*, Frederic Franceschi, MD^_*, Sebastien Renard, MD^_*, Ange Ferracci, MD^_*, Jean Lefevre, MD^_*, Roger Luccioni, MD, FACC^_*, Jean-Claude Deharo, MD^_* and Pierre Djiane, MD^_*

^_* Echocardiography Laboratory, La Timone Hospital, Marseille, France
Hôpital Louis Pradel, Lyon, France.

Manuscript received October 31, 2004; revised manuscript received January 12, 2005, accepted February 14, 2005.

^_* Reprint requests and correspondence: Prof. Gilbert Habib, Cardiology Department, Hôpital la Timone, Boulevard Jean Moulin, 13005 Marseille, France. (Email: gilbert.habib{at}free.fr).

OBJECTIVES: To compare the incidence of diastolic and systolic asynchrony, assessed by tissue Doppler imaging (TDI), in patients with congestive heart failure (CHF) and severe left ventricular (LV) dysfunction, and to assess TDI changes induced by cardiac resynchronization therapy (CRT).

BACKGROUND: Thirty percent of CRT candidates are nonresponders. Besides QRS width, the presence of echographic systolic asynchrony has been used to identify future responders. Little is known about diastolic asynchrony and its change after CRT.

METHODS: Tissue Doppler imaging was performed in 116 CHF patients (LV ejection fraction 26 ± 8%). Systolic and diastolic asynchrony was calculated using TDI recordings of right ventricular and LV walls.

RESULTS: The CHF group consisted of 116 patients. Diastolic asynchrony was more frequent than systolic, concerning both intraventricular (58% vs. 47%; p = 0.0004) and interventricular (72 vs. 45%; p < 0.0001) asynchrony. Systolic and diastolic asynchrony were both present in 41% patients, but one-third had isolated diastolic asynchrony. Although diastolic delays increased with QRS duration, 42% patients with narrow QRS presented with diastolic asynchrony. Conversely, 27% patients with large QRS had no diastolic asynchrony. Forty-two patients underwent CRT. Incidence of systolic intraventricular asynchrony decreased from 71% to 33% after CRT (p < 0.0001), but diastolic asynchrony decreased only from 81% to 55% (p < 0.0002). Cardiac resynchronization therapy induced new diastolic asynchrony in eight patients.

CONCLUSIONS: Diastolic asynchrony is weakly correlated with QRS duration, is more frequent than systolic asynchrony, and may be observed alone. Diastolic asynchrony is less improved by CRT than systolic. Persistent diastolic asynchrony may explain some cases of lack of improvement after CRT despite good systolic resynchronization.

Abbreviations and Acronyms   CHF = congestive heart failure   CRT = cardiac resynchronization therapy   LBBB = left bundle branch block   LVEF = left ventricular ejection fraction   TDI = tissue Doppler imaging

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