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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.

View larger version (69K): [in a new window]   Figure 1 Methods of measurements of systolic and diastolic delays. (A) Measurement of systolic intraventricular delay. Tissue Doppler imaging recordings of the velocity curves of the septal wall (blue curve) and of the lateral wall (white curve) in a patient with severe systolic intraventricular asynchrony. The onset of each systolic velocity curve is used for measurement of systolic electromechanical delays of each ventricular wall (dotted lines). A systolic intraventricular delay of 95 ms between these two walls is calculated (pink arrow). (B) Similar measurements are performed for measurement of diastolic intraventricular delay in the same patient. The onset of each diastolic velocity curve is used for measurement of diastolic electromechanical delays of each ventricular wall (dotted lines). A diastolic intraventricular delay of 115 ms between these two walls is calculated (pink arrow).

View larger version (87K): [in a new window]   Figure 2 Relative incidence of systolic and diastolic asynchrony in the congestive heart failure population. Purple = diastolic only; pink = systolic and diastolic; light blue = systolic only; blue = no dyssynchrony.

View larger version (25K): [in a new window]   Figure 3 Incidence of significant systolic and diastolic intraventricular asynchrony according to QRS duration in the CHF population (n = 108). (A) Incidence of systolic asynchrony. (B) Incidence of diastolic asynchrony. The white bars represent the relative proportion of patients with asynchrony in each group.

View larger version (23K): [in a new window]   Figure 4 Incidence of systolic (S) and diastolic (D) intraventricular and interventricular asynchrony at baseline (white bars) and under biventricular pacing (black bars) in the cardiac resynchronization therapy population (42 patients).