title: Ventricular coupling of electrical and mechanical dyssynchronization in heart failure patients.
abstract: We studied the relationships of electrical and mechanical synchronization in patients with heart failure (CHF) and various degree of ventricular conduction delays. Ninety-two CHF patients (60 +/- 13 years old, LVEF < 45%), NYHA II-III-IV, and 35 age-matched control subjects were studied with angioscintigraphic phase analysis. We measured ejection fractions (LVEF, RVEF) and calculated the total activation time for the left (TtLV) and right ventricle (TtRV), and the synchronization time between right and left ventricle (TRVLV), and between LV apex and base (Tab). Patients were divided into three groups according to QRS duration: group 1 < 120 ms (n = 28), group 2 < 150 ms (n = 23), group 3 > or = 150 ms (n = 41). In group 1: LVEF = 31.1 +/- 10.9%, RVEF = 30.1 +/- 12.6%, TtLV = 204 +/- 70 ms, TtRV = 183 +/- 61 ms, TRVLV = 7 +/- 33 ms, Tab = 29 +/- 23 ms. In group 2, these were: 27.8 +/- 9.1%, 27.8 +/- 8.8%, 227 +/- 95 ms, 248 +/- 137 ms, 35 +/- 42 ms*, and 39 +/- 53 ms respectively. In group 3: LVEF = 20.5 +/- 9.5%t, RVEF = 28.4 +/- 16.1%, TtLV = 304 +/- 155 mst, TtRV = 234 +/- 106 mst, TRVLV = 64 +/- 42 mst, and Tab = 67 +/- 48 ms*, all P < 0.001 versus controls *P < 0.05 versus G1, tP < or = 0.01 versus G1. A significant relation links QRS to both inter- and intraventricular asynchrony (TRVLV: r = 0.65; TtLL: r = 0.70, Tab: r = 0.60), and to LV function (r = 0.72); while LVEF relates more closely to intraventricular asynchrony: TtLV (r = 0.52), TtLL (r = 0.67), than to interventricular asynchrony: TRVLV (r = 0.48); P < 0.01, P < or = 0.001. In CHF patients, electromechanical and contractile alterations are coupled; regional activation may be an early parameter allowing the detection of ventricular dyssynchronization.
authors.affiliation: Physiology & Radioisotopes Unit, Hôpital Européen Georges Pompidou, Paris, France. jean-francois.toussaint@egp.ap-hop-paris.fr
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Toussaint
authors.forename: Thomas
authors.initials: T
authors.lastname: Lavergne
authors.forename: Khaldoun
authors.initials: K
authors.lastname: Kerrou
authors.forename: Barbara
authors.initials: B
authors.lastname: de Dieuleveult
authors.forename: Felizardo
authors.initials: F
authors.lastname: Ponce
authors.forename: Marc
authors.initials: M
authors.lastname: Froissart
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Le Heuzey
authors.forename: Louis
authors.initials: L
authors.lastname: Guize
authors.forename: Michel
authors.initials: M
authors.lastname: Paillard
mesh_terms: D002037:Bundle-Branch Block / Q000503:physiopathology; D016022:Case-Control Studies; D005260:Female; D015637:Gated Blood-Pool Imaging; D006329:Heart Conduction System / Q000503:physiopathology*; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right