Diastolic and Systolic Asynchrony in Patients With Diastolic Heart Failure
A Common but Ignored Condition
Cheuk-Man Yu, MD, FRACP, FRCP*,
Qing Zhang, MM,
Gabriel W.K. Yip, MD, FACC,
Pui-Wai Lee, MRCP,
Leo C.C. Kum, MRCP,
Yat-Yin Lam, MRCP and
Jeffrey Wing-Hong Fung, FHKAM
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
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Figure 1 Mechanical Asynchrony in Diastolic Heart Failure Observed by Tissue Doppler Imaging
(A) An example of a patient with diastolic heart failure (ejection fraction 62%) who had evidence of diastolic asynchrony as illustrated by the scattered time to peak early diastolic velocity (arrowheads). The systolic asynchrony is relatively mild (arrows). (B) Another patient with diastolic heart failure (ejection fraction 55%) who had evidence of systolic asynchrony as illustrated by the scattered time to peak systolic velocity (arrows). This patient had no evidence of diastolic asynchrony (arrowheads).
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Figure 2 The Distribution of Mechanical Asynchrony in Diastolic Heart Failure (DHF), Systolic Heart Failure (SHF), and Control
Scatter plot showing the distribution of systolic and diastolic asynchrony in patients with DHF, SHF, and the normal control group by: (A) the standard deviation (Te-SD) and (B) maximal difference (Te-diff) of the time to peak myocardial early diastolic velocity of the 12 left ventricular segments, and (C) the standard deviation (Ts-SD) and (D) maximal difference (Ts-diff) of the time to peak myocardial systolic velocity of the 12 left ventricular segments.
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Figure 3 The Correlation of Parameters for Assessing Mechanical Asynchrony
Scatter plot showing a close relationship between (A) the 2 methods of assessing diastolic asynchrony by Te-SD and Te-diff systolic asynchrony, and (B) the 2 methods of assessing systolic asynchrony by Ts-SD and Ts-diff. Abbreviations as in Figure 2.
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Figure 4 The Distribution of Mechanical Asychrony in DHF and SHF
Bar chart showing the percentage distribution of patients who developed mechanical asynchrony in DHF and SHF according to the (A) cutoff values of Te-SD >34 ms and Ts-SD >33 ms, and (B) cutoff values of Te-diff >113 ms and Ts-diff >100 ms. Patients with DHF had a higher prevalence of diastolic asynchrony or without asynchrony, whereas patients with SHF had more systolic asynchrony or co-existing diastolic and systolic asynchrony. The actual numbers are shown in parentheses. Abbreviations as in Figure 2.
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Figure 5 The Distribution of Mechanical Asynchrony in DHF and SHF Subdivided by QRS Duration
Bar chart showing the distribution of patients who developed (A) diastolic and (B) systolic asynchrony in patients with DHF and SHF according to the QRS duration of  120 and >120 ms. As wide QRS is uncommon in DHF, the majority of patients with diastolic and systolic asynchrony occurred in the narrow QRS group. Abbreviations as in Figure 2.
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