title: Is mechanical dyssynchrony a therapeutic target in heart failure with preserved ejection fraction?
abstract: BACKGROUND
  Previous studies have found a high frequency of mechanical dyssynchrony in patients with heart failure (HF) with preserved ejection fraction (HFpEF), hence suggesting that cardiac resynchronization therapy (CRT) may be considered in HFpEF. The present study was designed to compare the amount of mechanical dyssynchrony between HFpEF patients and (1) HF with reduced EF (HFrEF) patients with an indication for CRT (HFrEF-CRT(+)) group, (2) HFrEF patients with QRS duration < 120 ms (HFrEF-QRS < 120 ms) group, and (3) hypertensive controls (HTN).
  
  
  METHODS
  Electrical (ECG) and mechanical dyssynchrony (atrio-ventricular dyssynchrony, interventricular dyssynchrony, intraventricular dyssynchrony) were assessed using conventional, tissue Doppler, and Speckle Tracking strain echocardiography in 40 HFpEF patients, 40 age- and sex-matched HTN controls, 40 HFrEF-QRS < 120 ms patients, and 40 HFrEF-CRT(+) patients.
  
  
  RESULTS
  The frequency of left bundle branch block was low in HFpEF patients (5%) and similar to HTN controls (5%, P = 0.85). Indices of dyssynchrony were similar between HFpEF and HTN patients or HFrEF-QRS < 120 ms patients. In contrast, most indices of dyssynchrony differed between HFpEF and HFrEF-CRT(+) patients. The principal components analysis on the entire cohort of 160 patients yielded 2 homogeneous groups of patients in terms of dyssynchrony, the first comprising HFrEF-CRT(+) patients and the second comprising HTN, HFrEF-QRS < 120 ms and HFpEF patients.
  
  
  CONCLUSIONS
  Mechanical dyssynchrony in HFpEF does not differ from that of patients with HTN or patients with HFrEF and a narrow QRS. This data raises concerns regarding the role of dyssynchrony in the pathophysiology of HFpEF and thereby the potential usage of CRT in HFpEF.
authors.affiliation: Université Lille Nord de France/GCS-Groupement des hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Université Catholique de Lille, Lille, France.
authors.forename: Aymeric
authors.initials: A
authors.lastname: Menet
authors.affiliation: Université Lille Nord de France/GCS-Groupement des hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Université Catholique de Lille, Lille, France.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Greffe
authors.affiliation: CHU de Grenoble, France.
authors.forename: Pierre-Vladimir
authors.initials: PV
authors.lastname: Ennezat
authors.affiliation: Université Lille Nord de France/GCS-Groupement des hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Université Catholique de Lille, Lille, France.
authors.forename: François
authors.initials: F
authors.lastname: Delelis
authors.affiliation: Université Lille Nord de France/GCS-Groupement des hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Université Catholique de Lille, Lille, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Guyomar
authors.affiliation: Université Lille Nord de France/GCS-Groupement des hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Université Catholique de Lille, Lille, France.
authors.forename: Anne Laure
authors.initials: AL
authors.lastname: Castel
authors.affiliation: Université Lille Nord de France/GCS-Groupement des hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Université Catholique de Lille, Lille, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Guiot
authors.affiliation: Université Lille Nord de France/GCS-Groupement des hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Université Catholique de Lille, Lille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Graux
authors.affiliation: Pôle Cardiovasculaire et Thoracique, CHU d'Amiens, France; INSERM U 1088, Université de Picardie, Amiens, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
authors.affiliation: Université Lille Nord de France/GCS-Groupement des hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Université Catholique de Lille, Lille, France; INSERM U 1088, Université de Picardie, Amiens, France. Electronic address: sylvestre.marechaux@yahoo.fr.
authors.forename: Sylvestre
authors.initials: S
authors.lastname: Marechaux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002037:Bundle-Branch Block / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D015150:Echocardiography, Doppler / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012107:Research Design; D013318:Stroke Volume