Prognostic value of tissue Doppler-derived ventricular asynchrony in patients with left bundle branch block but not advanced heart failure.
OBJECTIVE
The aim of the present study was to evaluate the prognostic significance of tissue Doppler echocardiography (TDE)-derived ventricular asynchrony in patients with left bundle branch block (LBBB) but not advanced heart failure.


METHODS
Fifty-five patients (mean age 66 +/- 13 years; 33 male) with complete LBBB (QRS > 120 ms) hospitalized for an acute episode of decompensated heart failure and in New York Heart Association class II for at least 6 months before the study admission underwent standard Doppler echo and pulsed-wave TDE. Precontraction time (PCTm) from the beginning of Q wave of electrocardiogram to the onset of systolic myocardial velocity wave was evaluated in four different left ventricular (LV) basal myocardial segments (LV anterior, inferior, septal and lateral walls) and in one right ventricular (RV) lateral wall. Intraventricular activation delay (IntraV-del) was calculated by the difference of PCTm of each LV myocardial segment. Interventricular activation delay (InterV-del) was calculated by the difference of PCTm between the most delayed LV segment and RV lateral wall.


RESULTS
The mean value of EF was 40 +/- 9% and of InterV-del, IntraV-del was, respectively (97.4 +/- 46.7 and 57.9 +/- 35.5 ms). InterV-del was inversely related to EF (r = -0.68; P < 0001). During the follow-up (26 months, range 11-37 months) cardiac events were recorded in 23 (41%) patients: a worsening of heart failure (WHF) in 23 patients and cardiac death in ten patients. Cox proportional hazard multivariate analysis showed that age, and InterV-del [HR = 1.02 (P < 0.05) and 1.03 (P < 0005)] predicted mortality. A Receiver operating characteristic analysis showed that a cut-off value of InterV-del 100 ms (AUC = 0.86; P < 0001) predicted WHF and mortality with sensitivity and specificity of 75% and 90%; 81% and 84%, respectively.


CONCLUSIONS
TDE-derived interventricular asynchrony represents a prognostic indicator of major cardiac events at 2 years of follow-up in patients with LBBB but not advanced heart failure.
Citro
Rodolfo
R
U.O. UTIC-Cardiologia, San Luca Hospital, Vallo della Lucania, Salerno, Italy. rodolfocitro@tele2.it
D'Andrea
Antonello
A
Patella
Marco Mariano
MM
Ducceschi
Valentino
V
Provenza
Gennaro
G
De Luca
Giuseppe
G
Calabrò
Raffaele
R
Gregorio
Giovanni
G
D000367:Age Factors; D000368:Aged; D002037:Bundle-Branch Block / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D018450:Disease Progression; D018619:Echocardiography, Doppler, Pulsed; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology; D006333:Heart Failure / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D015203:Reproducibility of Results; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology