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Intra-left ventricular electromechanical asynchrony

A new independent predictor of severe cardiac events in heart failure patients

Hugues Bader, MD^*, Stephane Garrigue, MD^*,*, Stephane Lafitte, MD, Sylvain Reuter, MD^*, Pierre Jaïs, MD^*, Michel Haïssaguerre, MD^*, Jacques Bonnet, MD^*, Jacques Clementy, MD^* and Raymond Roudaut, MD

^* Hôpital Cardiologique du Haut-Lévêque, University of Bordeaux, Pessac, France
Echocardiography Laboratory, Hôpital Cardiologique du Haut-Lévêque, University of Bordeaux, Pessac, France

View larger version (98K): [in a new window]   Figure 1 (A) A series of tissue Doppler imaging (TDI) echocardiograms in a patient with primitive dilated cardiomyopathy with complete left bundle branch block (QRS width of 150 ms) and left ventricular ejection fraction of 21%. Despite a long QRS duration (B), this patient presents with no intra-left ventricular electromechanical asynchrony, because the anterior (A), inferior (I), septal (S), and lateral (L) electromechanical delays (between the onset of the QRS and that of the S wave observed on the TDI echocardiogram) are within a range of 30 ms. Respective electromechanical delay (EMD) of one given LV wall, between the onset of the QRS complex and that of the S wave observed on the TDI echocardiogram.

View larger version (25K): [in a new window]   Figure 2 (A) These congestive heart failure (CHF) event-free survival curves are for patients with and without intra-left ventricular electromechanical asynchrony. There were significantly more rehospitalizations for decompensation in patients with versus without intra-left ventricular asynchrony. (B) These CHF event-free survival curves are for patients with and without interventricular electromechanical asynchrony. The presence of interventricular asynchrony did not significantly influence the number of rehospitalization over one-year follow-up.