title: Radial dyssynchrony assessed by cardiovascular magnetic resonance in relation to left ventricular function, myocardial scarring and QRS duration in patients with heart failure.
abstract: BACKGROUND
  Intuitively, cardiac dyssynchrony is the inevitable result of myocardial injury. We hypothesized that radial dyssynchrony reflects left ventricular remodeling, myocardial scarring, QRS duration and impaired LV function and that, accordingly, it is detectable in all patients with heart failure.
  
  
  METHODS
  225 patients with heart failure, grouped according to QRS duration of <120 ms (A, n = 75), between 120-149 ms (B, n = 75) or >or=150 ms (C, n = 75), and 50 healthy controls underwent assessment of radial dyssynchrony using the cardiovascular magnetic resonance tissue synchronization index (CMR-TSI = SD of time to peak inward endocardial motion in up to 60 myocardial segments).
  
  
  RESULTS
  Compared to 50 healthy controls (21.8 +/- 6.3 ms [mean +/- SD]), CMR-TSI was higher in A (74.8 +/- 34.6 ms), B (92.4 +/- 39.5 ms) and C (104.6 +/- 45.6 ms) (all p < 0.0001). Adopting a cut-off CMR-TSI of 34.4 ms (21.8 plus 2xSD for controls) for the definition of dyssynchrony, it was present in 91% in A, 95% in B and 99% in C. Amongst patients in NYHA class III or IV, with a LVEF<35% and a QRS>120 ms, 99% had dyssynchrony. Amongst those with a QRS<120 ms, 91% had dyssynchrony. Across the study sample, CMR-TSI was related positively to left ventricular volumes (p < 0.0001) and inversely to LVEF (CMR-TSI = 178.3 e (-0.033 LVEF) ms, p < 0.0001).
  
  
  CONCLUSIONS
  Radial dyssynchrony is almost universal in patients with heart failure. This vies against the notion that a lack of response to CRT is related to a lack of dyssynchrony.
authors.affiliation: Centre for Cardiovascular Sciences, University of Birmingham, Department of Cardiology, Good Hope Hospital, Sutton Coldfield, UK. pwxfoley@doctors.org.uk
authors.forename: Paul W X
authors.initials: PW
authors.lastname: Foley
authors.forename: Kayvan
authors.initials: K
authors.lastname: Khadjooi
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Ward
authors.forename: Russell E A
authors.initials: RE
authors.lastname: Smith
authors.forename: Berthold
authors.initials: B
authors.lastname: Stegemann
authors.forename: Michael P
authors.initials: MP
authors.lastname: Frenneaux
authors.forename: Francisco
authors.initials: F
authors.lastname: Leyva
mesh_terms: D002304:Cardiac Pacing, Artificial; D016022:Case-Control Studies; D005355:Fibrosis; D006333:Heart Failure / Q000150:complications / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D009206:Myocardium / Q000473:pathology*; D012720:Severity of Illness Index; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling