Assessment of longitudinal and radial ventricular dyssynchrony in ischemic and nonischemic chronic systolic heart failure: a two-dimensional echocardiographic speckle-tracking strain study.
BACKGROUND
Current guidelines recommend a QRS greater than or equal to 120 milliseconds to select candidates for cardiac resynchronization therapy. However, ischemic and nonischemic cardiomyopathies are two different entities and they might be selected following different approaches. We sought, thus, after a validation the new 2-dimensional (2D) speckle-tracking strain (STS) against color Doppler tissue imaging (DTI)-strain (S) to compare the different correlation between electrical and mechanical dyssynchrony (DYS) in ischemic and nonischemic cardiomyopathies.


METHODS
We measured: (1) QRS duration; (2) mechanical interventricular DYS (the difference between preaortic and prepulmonary ejection times); (3) left intraventricular DYS (the SD of time-to-peak of longitudinal DTI-S); and (4) longitudinal and radial 2D-STS in the basal and middle segments of lateral and septal left ventricular walls in 95 patients with chronic heart failure caused by ischemic (n = 49) or nonischemic (n = 46) heart disease. Twelve healthy control subjects were also explored.


RESULTS
Mechanical interventricular DYS was correlated (DTI-S: P < .001) with QRS-duration, but not in ischemic heart disease. DTI-S and 2D-STS measurements were correlated (R = 0.6, P < .001) in the overall population. Longitudinal 2D-S DYS was correlated with QRS duration in patients with nonischemic, (P = .003) but not with ischemic heart disease, whereas radial 2D-S DYS was correlated with QRS width in both subgroups (r = 0.48, P = .003, and r = 0.43, P = .003, respectively).


CONCLUSIONS
The profile of DYS is influenced by the underlying cause of heart failure. The 2D-STS is a new tool for cardiac DYS assessment. Its ability to measure both longitudinal and radial intraventricular DYS is noteworthy.
Donal
Erwan
E
Department of Cardiology, University Hospital, Rennes, France.
Tournoux
François
F
Leclercq
Christophe
C
De Place
Christian
C
Solnon
Aude
A
Derumeaux
Geneviève
G
Mabo
Philippe
P
Cohen-Solal
Alain
A
Daubert
Jean-Claude
JC
D000328:Adult; D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D009202:Cardiomyopathies / Q000209:etiology; D016022:Case-Control Studies; D017023:Coronary Angiography; D004452:Echocardiography; D018619:Echocardiography, Doppler, Pulsed / Q000379:methods; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology*