Does Regional Wali Motion Abnormalities influence assessment of Dyssynchrony in Heart Failure

Author Block: Hygriv B. Rao, MD, Raghu Krishnaswamy, MD, Rajesh Badani, MD, Sharada Kalavakolunu, MD and Narasimhan Calambur, MD. Care Hospital and Care Foundation, Hyderabad, India

Assessment of ventricular dyssynchrony by Tissue Doppler imaging (TDI) in heart failure (HF) correlates with benefit from CRT.We aimed to study the influence of Regional Wall Motion Abnormalities(RWMA) on the assesssment of ventricular dyssynchrony in pts with HF who underwent TDI. Consecutive adult symptomatic HF pts with systolic LV dysfunction (LVEF< 40%) in sinus rhythm, receiving maximum medical therapy were included. Patients with predominant valvular heart disease or diastolic HF, recent coronary events were excluded. Pts had standard 2D-echocardigraphic examination and TDI on Vivid 5 Vingmed, Horten, Norway. Tissue velocity curves obtained by placing sample volumes in opposing basal and mid segments of septal, lateral, Inferior.Anterior and posterior walls were analysed offline using echopac software (Fig 1). Inter ventricular dyssynchrony (IVD) was assessed by the difference between aortic and pulmonary pre ejection intervals. LV dyssynchrony (LVD) was assessed by measuring the difference in times to peak velocity. IVD or LVD > 40 msec was considered signficant.Of the 70 pts who underwent TDI, 25 had RWMA(Gp1).and 45 had global hypokinesia (Gp 2) .21(84%) of the Gp 1 pts had involvement of LAD territory and 23 (92%) had septal hypokinesia (n= 13}or akinesia (n=10). 4 pts had hypokinesia or akinesia of lateral wall.Characteristics of pts in the 2 Gps were similar in terms of age& sex distribution, LVEF, mean QRS duration, and proprtion of wide QRS. The prevalence of IVD in the 2 Gps was36% and 38%.respectively. LVD was present in 43 pts (63%) overall, 64 % in Gp 1 and 60 % in Gp 2. Lateral wall delay was present in 26 pts (37 %) overall, 40% in Gp1 and 38% in Gp2. Septal delay was seen in 20% and 22% respctively..(P=NS)
Ventricular dyssynchrony ts present in a significant proportion of HF pts . Presence of RWMAdoes not influence the assessment of dyssynchrony by TDI .


Tissue Doppler Imaging in Refractory heart failure -Implications for CRT

Author Block: Hygriv B. Rao, MD, Raghu K, MD, Vipul Kapoor, MD, Sharada Kalavakolunu, MD, Narasimhan Calambur, MD and B. Soma. Raju, MD. Care Hospital and Care Foundation, Hyderabad, India

Assessment of Ventricular dyssynchrony in heart failure (HF) with Tissue Doppler imaging (TDI) correlates with benefit from CRT. We aimed to study the patterns of ventricular dyssynchrony in patients (pts) with HF using TDI and to assess the prevalence of interventricular and LV Dyssynchrony in patients with narrow and wide QRS (>120 msec). Adult HF pts with systolic LV dysfunction (LVEF< 40%) in sinus rhythm, refractory to optimal medical therapy referred for TDI were included. Pts with valvular heart disease or diastolic HF, recent cornary events were excluded. Pts had standard 2D-echocardigraphic examination and TDI on Vivid 5 Vingmed, Horten, Norway. Tissue velocity curves obtained by placing sample volumes in opposing basal and mid segments of Septal, Lateral, Inferior, Anterior and Posterior walls were analysed offline using customised software. Inter ventricular dyssynchrony (IVD) was assessed by the difference between aortic and pulmonary pre ejection intervals. LV dyssynchrony (LVD) was assessed by the difference in times to peak velocity. IVD or LVD > 40 msec was considered significant.70 pts(55 males &15 females) with mean age of 56+12 yrs were studied.Mean QRS duration was 136 + 36msec and mean LVEF was 31+6%. 48pts had wide QRS(mean 156+24 msec)and 22pts had narrow QRS (mean92+14msec).Wide QRS Gp included LBBB(n=25), RBBB(n=21) and IVCD(n=2). Overall 27 pts{38.5%) had IVD and 43{63 % )had LVD. LVD-was demonsrated in 1 wail in 36, 2 walls in 6 and > 2 wails in 3 pts. The distribution of LVD in lateral wall, and septal, wall was 37%, & 21% respectively. Pts with wide and narrow QRS were similar in ail respects and IVD in these pts differed (46% vs 4%,P<0.001) while LVD and lateral wall delay were simiiar(65% vs 59% & 35% vs 45%, P= NS). LVD was seen in 76% and 57 % of pts with LBBB and RBBB but lateral wall delay was seen in only 36% and in 33% of these pts.
LV dyssynchrony is present in about 2/3rds of HF pts and is present in a significant proportion of patients with narrow QRS, LBBB and RBBB.1/3rd of pts with standard indications for CRT do not have dyssynchrony.Lateral wall delay is seen in only 1/3rd of these pts These may have implications for pt selection and site of pacing in CRT.

Author Disclosure Block: H.B. Rao, None; R. K, None; V. Kapoor, None; S. Kalavakoiunu, None; N. Caiambur, None; B.S. Raju, None.