title: Diastolic asynchrony is more frequent than systolic asynchrony in dilated cardiomyopathy and is less improved by cardiac resynchronization therapy.
abstract: OBJECTIVE
  To compare the incidence of diastolic and systolic asynchrony, assessed by tissue Doppler imaging (TDI), in patients with congestive heart failure (CHF) and severe left ventricular (LV) dysfunction, and to assess TDI changes induced by cardiac resynchronization therapy (CRT).
  
  
  BACKGROUND
  Thirty percent of CRT candidates are nonresponders. Besides QRS width, the presence of echographic systolic asynchrony has been used to identify future responders. Little is known about diastolic asynchrony and its change after CRT.
  
  
  METHODS
  Tissue Doppler imaging was performed in 116 CHF patients (LV ejection fraction 26 +/- 8%). Systolic and diastolic asynchrony was calculated using TDI recordings of right ventricular and LV walls.
  
  
  RESULTS
  The CHF group consisted of 116 patients. Diastolic asynchrony was more frequent than systolic, concerning both intraventricular (58% vs. 47%; p = 0.0004) and interventricular (72 vs. 45%; p < 0.0001) asynchrony. Systolic and diastolic asynchrony were both present in 41% patients, but one-third had isolated diastolic asynchrony. Although diastolic delays increased with QRS duration, 42% patients with narrow QRS presented with diastolic asynchrony. Conversely, 27% patients with large QRS had no diastolic asynchrony. Forty-two patients underwent CRT. Incidence of systolic intraventricular asynchrony decreased from 71% to 33% after CRT (p < 0.0001), but diastolic asynchrony decreased only from 81% to 55% (p < 0.0002). Cardiac resynchronization therapy induced new diastolic asynchrony in eight patients.
  
  
  CONCLUSIONS
  Diastolic asynchrony is weakly correlated with QRS duration, is more frequent than systolic asynchrony, and may be observed alone. Diastolic asynchrony is less improved by CRT than systolic. Persistent diastolic asynchrony may explain some cases of lack of improvement after CRT despite good systolic resynchronization.
authors.affiliation: Echocardiography Laboratory, La Timone Hospital, Marseille, France.
authors.forename: Iris
authors.initials: I
authors.lastname: Schuster
authors.forename: Gilbert
authors.initials: G
authors.lastname: Habib
authors.forename: Christophe
authors.initials: C
authors.lastname: Jego
authors.forename: Franck
authors.initials: F
authors.lastname: Thuny
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Avierinos
authors.forename: Geneviève
authors.initials: G
authors.lastname: Derumeaux
authors.forename: Lionel
authors.initials: L
authors.lastname: Beck
authors.forename: Christine
authors.initials: C
authors.lastname: Medail
authors.forename: Frederic
authors.initials: F
authors.lastname: Franceschi
authors.forename: Sebastien
authors.initials: S
authors.lastname: Renard
authors.forename: Ange
authors.initials: A
authors.lastname: Ferracci
authors.forename: Jean
authors.initials: J
authors.lastname: Lefevre
authors.forename: Roger
authors.initials: R
authors.lastname: Luccioni
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Deharo
authors.forename: Pierre
authors.initials: P
authors.lastname: Djiane
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000209:etiology / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects; D002311:Cardiomyopathy, Dilated / Q000150:complications*; D003971:Diastole; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013599:Systole; D016896:Treatment Outcome; D018754:Ventricular Dysfunction / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*