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EXPEDITED REVIEW

Diastolic and Systolic Asynchrony in Patients With Diastolic Heart Failure

A Common But Ignored Condition

Li Ka Shing Institute of Health Sciences, Division of Cardiology, S.H. Ho Cardiovascular and Stroke Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China.

Manuscript received May 30, 2006; revised manuscript received August 1, 2006, accepted August 21, 2006.

^_* Reprint requests and correspondence: Dr. Cheuk-Man Yu, Li Ka Shing Institute of Health Sciences, Institute of Vascular Medicine, S.H. Ho Cardiovascular and Stroke Centre, Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, People’s Republic of China. (Email: cmyu{at}cuhk.edu.hk).

OBJECTIVES: The present study aimed to examine whether diastolic and systolic asynchrony exist in diastolic heart failure (DHF) and their prevalence and relationship to systolic heart failure (SHF) patients.

BACKGROUND: Few data exist on mechanical asynchrony in DHF.

METHODS: Tissue Doppler echocardiography was performed in 373 heart failure patients (281 with SHF and 92 with DHF) and 100 normal subjects. Diastolic and systolic asynchrony was determined by measuring the standard deviation of time to peak myocardial systolic (Ts-SD) and peak early diastolic (Te-SD) velocity using a 6-basal, 6-mid-segmental model, respectively.

RESULTS: Both heart failure groups had prolonged Te-SD (DHF vs. SHF vs. controls subjects: 32.2 ± 18.0 ms vs. 38.0 ± 25.2 ms vs. 19.5 ± 7.1 ms) and Ts-SD (31.8 ± 17.0 ms vs. 36.7 ± 15.2 ms vs. 17.6 ± 7.9 ms) compared with the control group (all p < 0.001 vs. control subjects). Based on normal values, the DHF group had comparable diastolic (35.9% vs. 43.1%; chi-square = 1.48, p = NS), but less systolic asynchrony than the SHF group (39.1% vs. 56.9%; chi-square = 8.82, p = 0.003). Normal synchrony, isolated systolic, isolated diastolic, and combined asynchrony were observed in 39.1%, 25.0%, 21.7%, and 14.1% of DHF patients, respectively, and these were 25.6%, 31.3%, 17.4%, and 25.6%, correspondingly, in SHF (chi-square = 10.01, p = 0.019). The correlation between systolic and diastolic asynchrony, and between the myocardial velocities and corresponding mechanical asynchrony appeared weak. A wide QRS duration (>120 ms) was rare in DHF (10.9% vs. 37.7% in SHF) (chi-square = 16.69, p < 0.001).

CONCLUSIONS: Diastolic and/or systolic asynchrony was common in 61% of DHF patients despite narrow QRS complex. The presence of asynchrony was not related to myocardial systolic or diastolic function. Systolic and diastolic asynchrony were not tightly coupled, implying distinct mechanisms.

Abbreviations and Acronyms   DHF = diastolic heart failure   LV = left ventricle/ventricular   SHF = systolic heart failure   TDI = tissue Doppler imaging   Te = time to peak myocardial early diastolic velocity   Te-diff = maximal difference in Te   Te-SD = standard deviation of Te   Ts = time to peak myocardial systolic velocity during the ejection phase   Ts-diff = the maximal difference in Ts   Ts-SD = standard deviation of Ts

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