title: Left ventricular dyssynchrony in patients with heart failure and preserved ejection fraction.
abstract: OBJECTIVE
  Mechanical dyssynchrony has been postulated to play a pathophysiologic role in heart failure with preserved ejection fraction (HFpEF).
  
  
  RESULTS
  We quantified left ventricular (LV) systolic dyssynchrony in 130 HFpEF patients with NYHA class II-IV symptoms, ejection fraction (EF) ≥45%, and NT-proBNP levels >400 pg/mL enrolled in the PARAMOUNT trial, and compared them to 40 healthy controls of similar age and gender. Dyssynchrony was assessed by 2D speckle tracking as standard deviation (SD) of time to peak longitudinal systolic strain in 12 ventricular segments and related to measures of systolic and diastolic function. Heart failure with preserved ejection fraction patients (62% women, mean age of 71 ± 9 years, body mass index of 30.2 ± 5.9 kg/m(2), systolic blood pressure 139 ± 15 mmHg) demonstrated significantly greater dyssynchrony than controls (SD of time to peak longitudinal strain; 90.6 ± 50.9 vs. 56.4 ± 33.5 ms, P < 0.001), even in the subset of patients (n = 63) with LVEF ≥55% and narrow QRS (≤100 ms). Among HFpEF patients, dyssynchrony was related to wider QRS interval, higher LV mass, and lower early diastolic tissue Doppler myocardial velocity (E'). Greater dyssynchrony remained significantly associated with worse diastolic function even after restricting the analysis to patients with EF≥55% and adjusting for age, gender, systolic blood pressure, LV mass index, and LVEF.
  
  
  CONCLUSIONS
  Heart failure with preserved EF is associated with greater mechanical dyssynchrony compared with healthy controls of similar age and gender. Within an HFpEF population, the severity of dyssynchrony is related to the width of QRS complex, LV hypertrophy, and diastolic dysfunction.
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02445, USA.
authors.forename: Angela B S
authors.initials: AB
authors.lastname: Santos
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Kraigher-Krainer
authors.forename: Natalie
authors.initials: N
authors.lastname: Bello
authors.forename: Brian
authors.initials: B
authors.lastname: Claggett
authors.forename: Michael R
authors.initials: MR
authors.lastname: Zile
authors.forename: Burkert
authors.initials: B
authors.lastname: Pieske
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: Milton
authors.initials: M
authors.lastname: Packer
authors.forename: Toni
authors.initials: T
authors.lastname: Bransford
authors.forename: Marty
authors.initials: M
authors.lastname: Lefkowitz
authors.forename: Amil M
authors.initials: AM
authors.lastname: Shah
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000378:metabolism / Q000503:physiopathology; D016022:Case-Control Studies; D002986:Clinical Trials as Topic; D015150:Echocardiography, Doppler; D005260:Female; D054144:Heart Failure, Diastolic / Q000503:physiopathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000378:metabolism / Q000503:physiopathology*
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Dyssynchrony; Heart failure with preserved ejection fraction; Speckle tracking