Document Detail

Effect of dynamic myocardial dyssynchrony on mitral regurgitation during supine bicycle exercise stress echocardiography in patients with idiopathic dilated cardiomyopathy and 'narrow' QRS.
MedLine Citation:
PMID:  17400608     Owner:  NLM     Status:  MEDLINE    
AIMS: Cardiac resynchronization therapy (CRT) has become an attractive therapeutic option for patients with end-stage heart failure (HF). Currently, patients are selected for CRT on ECG and on echocardiographic criteria analysed at rest. Whether the physical effort may further increase myocardial dyssynchrony is not fully established. The aim of the study was to test by the use of Doppler myocardial imaging (DMI) if dynamic left ventricular (LV) dyssynchrony during physical effort may be a determinant of dynamic mitral regurgitation in patients with dilated cardiomyopathy and 'narrow' QRS. METHODS AND RESULTS: Sixty patients (62.3 +/- 8.3 years) with idiopathic dilated cardiomyopathy and narrow QRS duration ( < 120 ms) were selected. All the patients underwent standard Doppler echo, colour DMI, supine bicycle exercise stress echocardiography, and cardiopulmonary exercise testing. Cardiac synchronicity was assessed, at rest and at peak exercise, from measurements of time intervals (Ts) between the onset of the QRS complex and the peak myocardial systolic velocity, in a six-basal-six-mid-segmental model. Standard deviation of Ts of the 12 LV segments (Ts-SD-12) was also calculated. In baseline conditions, HF patients showed an LV ejection fraction of 30.1 +/- 4%, and a significant electromechanical delay (Ts-SD-12 > or = 34.4 ms) in 20 patients (33.3%). At peak of physical exercise, a significant electromechanical delay was detected in 35 patients (58.3%), whereas in 47 patients (78.3%) exercise-induced increase in mitral valve effective regurgitant orifice (ERO) was observed. By multivariable analysis, an independent positive association between changes in Ts-SD-12 and in mitral valve ERO (P < 0.0001), as well as an independent inverse correlation of the same changes in Ts-SD-12 with LV stroke volume (P < 0.0001) were detected. In addition, changes in Ts-SD-12 were also independent determinants of peak VO(2) (P < 0.0001) during cardiopulmonary exercise testing. CONCLUSION: Colour DMI is an effective technique for assessing the severity of regional delay in activation of LV walls in HF patients with narrow QRS both at rest and during stress test. The increase in LV dyssynchrony during exercise strongly correlates with the increase in mitral regurgitation severity and with the impairment of LV stroke volume.
Antonello D'Andrea; Pio Caso; Sergio Cuomo; Raffaella Scarafile; Gemma Salerno; Giuseppe Limongelli; Giovanni Di Salvo; Sergio Severino; Luigi Ascione; Paolo Calabrò; Massimo Romano; Gianpaolo Romano; Lucio Santangelo; Ciro Maiello; Maurizio Cotrufo; Raffaele Calabrò
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2007-03-30
Journal Detail:
Title:  European heart journal     Volume:  28     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-04-20     Completed Date:  2007-11-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  1004-11     Citation Subset:  IM    
Second University of Naples, Italy.
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MeSH Terms
Cardiomyopathy, Dilated / complications*
Echocardiography, Doppler, Color
Echocardiography, Stress / methods
Exercise / physiology*
Exercise Test / methods
Middle Aged
Mitral Valve Insufficiency / complications*,  diagnosis
Observer Variation
Oxygen Consumption
Ventricular Dysfunction, Left / diagnosis,  etiology*
Comment In:
Eur Heart J. 2007 Oct;28(20):2554; author reply 2554-5   [PMID:  17855739 ]
Eur Heart J. 2007 Apr;28(8):924-5   [PMID:  17430996 ]

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