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EXPEDITED REVIEW

Systolic and Diastolic Dyssynchrony in Patients With Diastolic Heart Failure and the Effect of Medical Therapy

Department of Cardiology and Methodist DeBakey Heart Center, The Methodist Hospital, Houston, Texas.

Manuscript received June 8, 2006; revised manuscript received July 25, 2006, accepted August 14, 2006.

^_* Correspondence and reprint requests: Dr. Sherif F. Nagueh, 6550 Fannin Street, SM-667, Houston, Texas 77030-2717. (Email: snagueh{at}tmh.tmc.edu).

OBJECTIVES: The purpose of this study was to determine the prevalence of systolic and diastolic dyssynchrony in diastolic heart failure (DHF) patients and identify the effects of medical therapy.

BACKGROUND: The prevalence of systolic and diastolic dyssynchrony in DHF patients is unknown with no data on the effects of medical therapy on dyssynchrony.

METHODS: Patients presenting with DHF (n = 60; 61 ± 9 years old, 35 women) underwent echocardiographic imaging simultaneous with invasive measurements. An age-matched control group of 35 subjects and 60 patients with systolic heart failure (SHF) were included for comparison. Systolic and diastolic dyssynchrony were assessed by tissue Doppler and defined using mean and SD values in the control group.

RESULTS: Systolic dyssynchrony was present in 20 patients (33%) with DHF and 24 patients (40%) with SHF and was associated in both groups with significantly worse left ventricular (LV) systolic and diastolic properties (p < 0.05 vs. control group and patients without systolic dyssynchrony). Diastolic dyssynchrony was present in 35 patients (58%) with DHF and 36 patients (60%) with SHF and had significant inverse correlations with mean wedge pressure and time constant of LV relaxation. In DHF patients, medical therapy resulted in significant shortening of diastolic time delay (39 ± 23 ms to 28 ± 20 ms; p = 0.02) but no significant change in systolic interval (p = 0.15). Shortening of diastolic time delay correlated well with shortening after therapy (r = 0.85; p < 0.001).

CONCLUSIONS: Systolic dyssynchrony occurs in 33% of DHF patients, and diastolic dyssynchrony occurs in 58%. Medical therapy results in significant shortening of the diastolic intraventricular time delay which is closely related to improvement in LV relaxation.

Abbreviations and Acronyms   DHF = diastolic heart failure   EF = ejection fraction   ESP = end-systolic pressure   ESV = end-systolic volume   LA = left atrial   LV = left ventricular   PCWP = pulmonary capillary wedge pressure   SHF = systolic heart failure   SW = stroke work   TD = tissue Doppler

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