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Figure 9 Tissue Doppler imaging in a patient with heart failure and narrow QRS complex, showing left ventricular (LV) dyssynchrony in multiple segments (top, middle, and bottom panels) as illustrated by the temporal difference in peak systolic velocity during the ejection phase (arrows). (Top) Tissue Doppler imaging velocity tracings obtained in the interventricular septum (yellow and light blue curves) and lateral wall (red and green curves). Earliest activation (peak systolic velocities, first arrow) is in the septum, and latest activation in the lateral wall (peak systolic velocities, second arrow). Thus, significant LV dyssynchrony is present between the septum and the lateral wall. (Middle) Tissue Doppler imaging velocity tracings obtained in the anterior wall (red and green curves) and inferior wall (yellow and light blue curves). Earliest activation (peak systolic velocities, first arrow) is in the anterior wall, and latest activation in the inferior wall (peak systolic velocities, second arrow). Thus, significant LV dyssynchrony exists between the anterior and inferior wall. (Bottom) Tissue Doppler imaging velocity tracings obtained in the anteroseptal wall (red and green curves) and posterior (yellow and light blue curves). Earliest activation (peak systolic velocities, first arrow) is in the anteroseptal wall, and latest activation in the posterior wall (peak systolic velocities, second arrow). Thus, significant LV dyssynchrony is present between the anteroseptal and posterior wall. AVC = aortic valve closure; AVO = aortic valve opening.
