CLINICAL RESEARCH: HEART FAILURE
Beta-Blocker Therapy Induces Ventricular Resynchronization in Dilated Cardiomyopathy With Narrow QRS Complex
Yasuhiko Takemoto, MD, PhD*,*,
Takeshi Hozumi, MD, PhD, FACC*,
Kenichi Sugioka, MD, PhD*,
Yasuhiro Takagi, MD, PhD*,
Yoshiki Matsumura, MD, PhD*,
Minoru Yoshiyama, MD, PhD*,
Theodore P. Abraham, MD, FACC and
Junichi Yoshikawa, MD, PhD, FACC
* Department of Internal Medicine and Cardiology, Osaka City University School of Medicine, Osaka, Japan
Division of Cardiology, John Hopkins University, Baltimore, Maryland
Department of Cardiology, Osaka Ekisaikai Hospital, Osaka, Japan.
Manuscript received January 17, 2006;
revised manuscript received April 19, 2006,
accepted May 22, 2006.
* Reprint requests and correspondence to: Dr. Yasuhiko Takemoto, Department of Internal Medicine and Cardiology, Osaka City University School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585 Japan. (Email: yatakemoto{at}med.osaka-cu.ac.jp).
OBJECTIVES: We sought to evaluate the effects of beta-blocker therapy on regional and global myocardial mechanics in addition to ventricular synchrony in patients with heart failure and normal QRS by using tissue Doppler and strain echocardiography.
BACKGROUND: It is unknown whether beta-blocker therapy can influence mechanical synchrony.
METHODS: Conventional and strain echocardiography were performed in 15 healthy age-matched volunteers and in 25 patients with idiopathic dilated cardiomyopathy (IDC). Of these, 15 IDC patients on standard heart failure therapy were studied prior to and at 1 and 6 months after initiation of carvedilol therapy and compared to the controls.
RESULTS: There was significant mechanical dyssynchrony in IDC compared with control patients. Patients placed on carvedilol demonstrated a significant decrease in the inferoseptal to lateral wall delay in peak strain (normalized to the R-R interval) between baseline and 1 month and between baseline and 6 months. Similarly, global time to peak segmental strain (455 ± 51 ms vs. 423 ± 59 ms, respectively, p = 0.02, and 455 ± 51 ms vs. 415 ± 50 ms, respectively, p = 0.01) and the coefficient of variation of the time to peak segmental strain decreased (17 ± 4% vs. 15 ± 5%, respectively, p = 0.02, and 17 ± 4% vs. 14 ± 5%, respectively, p = 0.03), from baseline to 1 month and between baseline and 6 months, respectively. Global strain significantly increased from baseline to 1 month (–8.2 ± 1.8 to –10.4 ± 3.9, respectively, p = 0.01) and between baseline and 6 months (–8.2 ± 1.8% to –12.0 ± 3.2%, respectively, p = 0.008). Improvements in left ventricular ejection fraction and reverse remodeling were coincident with reductions in mechanical dyssynchrony.
CONCLUSIONS: The use of carvedilol improves contractile function and dyssynchrony in heart failure patients with normal QRS.
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Abbreviations and Acronyms
| | CV = coefficient of variation | CV = coefficient of variation of segmental values | | CVT = coefficient of variation of segmental T | | global = averaged segmental strain values over 12 segments | | global T = averaged segmental T values over 12 segments | | HF = heart failure | | HF-N = heart failure with narrow QRS complex (<120 ms) | | IDC = idiopathic dilated cardiomyopathy | | SE = tissue Doppler derived strain echocardiography | | segmental = peak systolic strain in a segment | | segmental T = time from the R-wave of the electrocardiogram trace to peak systolic strain in a particular segment | | TDE = tissue Doppler echocardiography |
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