Prevalence and inter-relationship of different Doppler measures of dyssynchrony in patients with heart failure and prolonged QRS: a report from CARE-HF

Determining whether LV filling time contributes to HF symptoms in different widths of QRS in LBBB patients: A clinical study

OBJECTIVES

Accurate assessment of left ventricular (LV) function is essential for managing patients with left bundle branch block (LBBB). This study aimed to evaluate the relationship between LV systolic function, left ventricular diastolic filling time (LVFT), QRS duration, and heart failure symptoms in patients with LBBB.

METHODS

This study was conducted between June 2021 and June 2022. Patients with LBBB and sinus rhythm who were referred to the echocardiography department were included in the study. All the patients underwent electrocardiogram-gated echocardiography using the same machine. In this study, the LVFT value was measured in absolute terms and as a ratio to the R-R interval (LVFT/RR).

RESULTS

A total of sixty-five patients were included, forty-two (64.6%) were women, and the mean age was 60.71 ± 8.72. We performed three one-way ANOVA tests that showed that LV filling time/RR ratio, QRS duration, and ejection fraction were significantly different between heart failure classes (p = 0.008, p = 0.001, and p < 0.001, respectively). A weak correlation was observed between LVEF and LVFT/RR (r = 0.349, p = 0.004). Additionally, QRS duration was negatively correlated with LVEF (r =  - 0.395, p = 0.004) and LVFT/RR (r =  - 0.350, p = 0.004), although these correlations were weak.

CONCLUSION

We showed that LVFT/RR ratio differed significantly between HF functional classes and was lower in patients with more severe HF symptoms. Additionally, QRS duration was negatively correlated with LVEF and LVFT/RR, and patients with more severe HF symptoms had longer QRS durations.

Incomplete recovery of mechanical and endocrine left atrial functions one month after electrical cardioversion for persistent atrial fibrillation: a pilot study

Background

Restoration of the mechanical and endocrine functions of the left atrium remains controversial after electrical cardioversion treatment for persistent atrial fibrillation. The objective of the prospective study was to describe the recovery of the endocrine and mechanical functions of the left atrium.

Methods

Evaluation of left atrium recovery after electrical cardioversion by the new speckle-tracking echocardiography technique and proANP measurement.

Results

Twenty patients suffering from persistent atrial fibrillation with no alteration of left ventricular ejection fraction were prospectively evaluated at baseline and then one month later by echocardiography, measuring left atrial volume and left atrial deformation (MPALS), as well as the proANP and BNP concentrations. One month after cardioversion 10 patients remained in sinus rhythm and 10 showed recurrent atrial fibrillation. No significant differences between the two groups in terms of clinical, echocardiographic and endocrine parameters were observed at baseline evaluation. We observed a significant reduction of left atrial volume only in the sinus group, whereas restoration of the left atrial deformation was only partial (18%) in that group. By contrast, we registered no significant changes in ANP concentration at one month in either the sinus or the atrial fibrillation groups.

Conclusion

These results suggest that restoration of left atrium mechanical function is only partial one month after treatment of persistent atrial fibrillation by electrical cardioversion, whereas a significant reduction of left atrial volume was noted, explaining the remaining high level of ANP in the sinus group.

Comparison between tissue doppler imaging (TDI) and tissue synchronization imaging (TSI) in evaluation of left ventricular dyssynchrony in patients with advanced heart failure

BACKGROUND

Assessment of left ventricular (LV) dyssynchrony has an important role in optimizing the selection of cardiac resynchronization therapy (CRT) candidates. We compared a new semiautomatic echocardiographic modality, tissue synchronization imaging (TSI) with a manual method, color-coded tissue Doppler imaging (TDI), in the assessment of LV dyssynchrony in patients with heart failure (HF).

METHODS

Ninety-five patients (age = 54.5 ± 17.1 years, 66.3% male) with advanced HF (NYHA functional class ≥III and ejection-fraction ≤35%) were included in the study and evaluated echocardiographically. The time to regional peak systolic velocity (Ts) in six basal and six middle segments of the LV was measured manually using velocity curves from TDI and semiautomatically using TSI and seven parameters of systolic dyssynchrony were computed.

RESULTS

Overall, a moderate-to-good association was found between Ts derived by these two modalities, whereas the mean of Ts via TSI was significantly lower than that measured by TDI in many LV segments. The agreement between these two modalities in identifying LV dyssynchrony varied from weak to moderate according to various dyssynchrony indices. In comparison to the TDI-derived dyssynchrony indices, TSI showed a high sensitivity of more than 90% using Ts delay at the basal/all LV segments and the indices for their standard deviations (SD) for identifying LV dyssynchrony, whereas the highest specificity of 80% was achieved using the septal-lateral dyssynchrony index in the prediction of LV dyssynchrony.

CONCLUSION

With the aid of selected LV dyssynchrony indices, the TSI method may confer enough sensitivity for a speedy evaluation and initial screening of LV dyssynchrony in HF patients; however, the current technology of TSI does not seem specific enough to replace TDI in the evaluation of dyssynchrony.

Sequential biventricular pacing improves regional contractility, longitudinal function and dyssynchrony in patients with heart failure and prolonged QRS

AIMS

Biventricular pacing (BiP) is an effective treatment in systolic heart failure (HF) patients with prolonged QRS. However, approximately 35% of the patients receiving BiP are classified as non-responders. The aim of this study is to evaluate the acute effects of VV-optimization on systolic heart function.

METHODS

Twenty-one HF patients aged 72 (46-88) years, QRS 154 (120-190) ms, were studied with echocardiography, Tissue Doppler Imaging (TDI) and 3D-echo the first day after receiving a BiP device. TDI was performed; during simultaneous pacing (LV-lead pacing 4 ms before the RV-lead) and during sequential pacing (LV 20 and 40 ms before RV and RV 20 and 40 ms before LV-lead pacing). Systolic heart function was studied by tissue tracking (TT) for longitudinal function and systolic maximal velocity (SMV) for regional contractility and signs of dyssynchrony assessed by time-delays standard deviation of aortic valve opening to SMV, AVO-SMV/SD and tissue synchronization imaging (TSI).

RESULTS

The TT mean value preoperatively was 4.2 +/- 1.5 and increased at simultaneous pacing to 5.0 +/- 1.2 mm (p < 0.05), and at best VV-interval to 5.4 +/- 1.2 (p < 0.001). Simultaneous pacing achieved better TT distance compared with preoperative in 16 patients (76%). However, it was still higher after VV-optimization in 12 patients 57%. Corresponding figures for SMV were 3.0 +/- 0.7, 3.5 +/- 0.8 (p < 0,01), and 3.6 +/- 0.8 (p < 0.001). Also dyssynchrony improved.

CONCLUSIONS

VV-optimization in the acute phase improves systolic heart function more than simultaneous BiP pacing. Long-term effects should be evaluated in prospective randomized trials.