title: Effect of intraventricular dyssynchrony on diastolic function and exercise tolerance in patients with heart failure.
abstract: OBJECTIVE
  Intraventricular dyssynchrony may contribute to the severity of heart failure [congestive heart failure (CHF)]. We assessed the correlates of intraventricular dyssynchrony and evaluated dyssynchrony as an independent predictive variable of exercise intolerance in CHF patients.
  
  
  RESULTS
  Eighty-one CHF patients (66 +/- 9 years) underwent cardiopulmonary exercise test. Left ventricular (LV) diastolic function was evaluated by transmitral patterns and tissue Doppler. Intraventricular dyssynchrony was calculated according to time intervals between the onset of QRS and the onset of systolic velocities of basal septum and lateral wall. We divided the patients based on the mean value (40 ms) of dyssynchrony. Patients with intraventricular dyssynchrony (>40 ms) showed higher New York Heart Association class (2.7 +/- 0.6 vs. 2.2 +/- 0.4, P < 0.001), higher brain natriuretic peptide (BNP) (415 +/- 478 vs. 194 +/- 205, P = 0.014), more frequent restrictive transmitral pattern (33 vs. 7%, P = 0.013), higher E/E(a) (13 +/- 7 vs. 10 +/- 6, P = 0.016), lower mitral annulus peak systolic velocity (4.5 +/- 1.1 vs. 5.5 +/- 1.5 cm/s, P = 0.01), and peak oxygen consumption (13.8 +/- 3.5 vs. 18.1 +/- 3.9, P < 0.001), than patients without dyssynchrony (< or =40 ms). Predictors of exercise tolerance were intraventricular dyssynchrony (P = 0.035), log BNP (P = 0.003), and E/E(a) (P = 0.004).
  
  
  CONCLUSIONS
  Intraventricular dyssynchrony correlates with higher LV filling pressure and lower ejection fraction and it is an independent predictor of poor aerobic capacity; it may be helpful for functional evaluation of CHF patients.
authors: Division of Cardiology, Fatebenefratelli Hospital, Viale Principe di Napoli, 12, I-82100 Benevento, Italy. qciampi@iol.it
authors: Quirino
authors: Q
authors: Ciampi
authors: Bruno
authors: B
authors: Petruzziello
authors: Michele
authors: M
authors: Della Porta
authors: Salvatore
authors: S
authors: Caputo
authors: Vincenzo
authors: V
authors: Manganiello
authors: Costantino
authors: C
authors: Astarita
authors: Bruno
authors: B
authors: Villari
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003971:Diastole / Q000502:physiology; D015150:Echocardiography, Doppler; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D016014:Linear Models; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010101:Oxygen Consumption / Q000502:physiology; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*
chemical_list: D020097:Natriuretic Peptide, Brain