title: Correlation of mechanical dyssynchrony with QRS duration measured by signal-averaged electrocardiography.
abstract: BACKGROUND
  Preimplantation left ventricular dyssynchrony is considered a prerequisite for a beneficial response to cardiac resynchronization therapy (CRT). However, electrical dyssynchrony estimated by QRS duration (QRSd) on ECG has not been proven to be an optimal surrogate of mechanical dyssynchrony. We evaluated the correlation of mechanical dyssynchrony with QRSd as measured by signal-averaged electrocardiography (SAECG) in comparison with measurements based on conventional surface ECG and with onscreen measurements based on digital ECG.
  
  
  METHODS
  We included 49 consecutive patients with decompensated heart failure (40 men, aged 66.8 +/- 9.5 years), New York Heart Association (NYHA) class II-IV, and LVEF < or = 40%. QRSd was calculated by manual measurement of 12-lead ECG, on-screen measurement of computer-based ECG, and calculation of total ventricular activation time on SAECG.
  
  
  RESULTS
  Only 60.4% of the studied patients had QRS > or = 120 ms based on measurements derived by SAECG compared to 69.4% by using on-screen measurement of computer-based ECG and 73.5% based on surface ECG (P=0.041). Interventricular but not intraventricular delay was correlated with QRSd. The correlation of interventricular dyssynchrony with QRSd was stronger when measured by SAECG than by surface ECG (r=0.45, P=0.001 vs r=0.35, P < 0.01). Among patients with ischemic cardiomyopathy, no significant correlation was demonstrated between mechanical dyssynchrony and QRSd. In nonischemic patients, interventricular delay was significantly correlated with QRSd measured by surface ECG (r=0.45, P < 0.05) and SAECG (r=0.46, P < 0.05).
  
  
  CONCLUSIONS
  The use of SAECG results in different patient classification in wide QRS complex category as compared to surface ECG. Furthermore, QRSd measured by SAECG is correlated with interventricular but not intraventricular dyssynchrony in heart failure patients.
authors.affiliation: First Department of Cardiology, Evagelismos General Hospital, Athens, Greece. andrikop@hotmail.com
authors.forename: George K
authors.initials: GK
authors.lastname: Andrikopoulos
authors.forename: Stylianos
authors.initials: S
authors.lastname: Tzeis
authors.forename: Christof
authors.initials: C
authors.lastname: Kolb
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Sakellariou
authors.forename: Dimosthenes
authors.initials: D
authors.lastname: Avramides
authors.forename: Evangelos C
authors.initials: EC
authors.lastname: Alexopoulos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Triantafyllou
authors.forename: Antonis S
authors.initials: AS
authors.lastname: Manolis
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D004452:Echocardiography; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*