Impact of ventricular dyssynchrony on postexercise accommodation of systolic myocardial motion in hypertensive patients with heart failure and a normal ejection fraction: a tissue-Doppler echocardiography study.
BACKGROUND
We hypothesized left ventricular (LV) dyssynchrony would affect postexercise accommodation of regional myocardial motion in patients with heart failure and a normal ejection fraction (HFNEF).


RESULTS
Tissue-Doppler echocardiography was studied in 100 hypertensive patients with LV ejection fraction >50%. Among them, 70 HFNEF patients were classified into the systolic dyssynchrony (Dys: >65 ms difference of electromechanical delay between septal and lateral segments) (43 patients) and nondyssynchrony (Ndys: 27 patients) groups, and the other 30 patients were as the control (Ctrl). The systolic myocardial velocities (Sm) of 6-basal LV segments at baseline and after exercise were analyzed. When compared with the Ctrl group, the baseline lower mean Sm of 6 LV segments in the Ndys group could increase to a similar postexercise level as that in the Ctrl group, whereas that in the Dys group remained lower after exercise (7.8 ± 1.3 versus Ndys: 8.6 ± 1.5 and Ctrl: 8.9 ± 1.2 cm/s, P < .05, respectively). This is mainly due to a much higher percentage increase of lateral Sm after exercise in the Ndys group (Ndys: 49 versus Dys: 29%, P < .05).


CONCLUSIONS
Dyssynchrony-related regional myocardial contractile abnormality after exercise in HFNEF patients suggested the detrimental impact of electromechanical uncoupling on HF symptoms.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Yi-Chih
YC
Wang
Chih-Chieh
CC
Yu
Fu-Chun
FC
Chiu
Ruth
R
Klepfer
Kathryn
K
Hilpisch
Vincent
V
Splett
Chia-Ti
CT
Tsai
Ling-Ping
LP
Lai
Juey-Jen
JJ
Hwang
Jiunn-Lee
JL
Lin
D000368:Aged; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D013318:Stroke Volume; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*