Document Detail

Evaluation of mechanical dyssynchrony in children with idiopathic dilated cardiomyopathy and associated clinical outcomes.
MedLine Citation:
PMID:  18394457     Owner:  NLM     Status:  MEDLINE    
We studied mechanical dyssynchrony and its association with clinical status in children with idiopathic dilated cardiomyopathy (IDC). The SD of QRS to peak systolic velocity interval by tissue Doppler was measured in 12 left ventricular segments, as a dyssynchrony index (DI), in each child with IDC during a 12-month period. Results were compared with a control cohort. We used the adult-defined DI cutpoint of 32.6 ms to define patients with IDC as "dyssynchronous" or "synchronous" and compared clinical status and outcomes (transplantation listing/death) between these groups. Patients with IDC (n = 23) and controls (n = 14) had similar age, gender, and QRS duration. Patients with IDC had a higher DI than controls (44.8 +/- 23.7 vs 19.9 +/- 8 ms, p <0.0001). A DI >32.6 ms defined mechanical dyssynchrony in 65% of patients with IDC. Dyssynchronous and synchronous patients had similar QRS durations. Age at diagnosis, at dyssynchrony evaluation, and duration of clinical illness were similar in the 2 groups. New York Heart Association score was better in dyssynchronous than in synchronous patients (2 vs 3.1, p <0.05). Number of synchronous and dyssynchronous patients reaching the end point of death or transplantation was similar, although synchronous patients had poorer actuarial survival from the time of diagnosis (hazard ratio 3.25, p = .04). In conclusion, left ventricular mechanical dyssynchrony is prevalent in pediatric IDC. QRS duration alone is inadequate to define dyssynchrony in pediatric IDC, whereas the adult-derived DI of >32.6 ms seems applicable to the pediatric population. In this cohort, the presence of mechanical dyssynchrony was not associated with more severe clinical status or adverse outcomes.
Mark Kevin Friedberg; Susan Lucy Roche; Mervin Balasingam; Elizabeth Stephenson; Cameron Slorach; Cheryl Fackoury; Paul Fraser Kantor
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Publication Detail:
Type:  Journal Article     Date:  2008-03-04
Journal Detail:
Title:  The American journal of cardiology     Volume:  101     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-04-08     Completed Date:  2008-06-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1191-5     Citation Subset:  AIM; IM    
Division of Pediatric Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada.
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MeSH Terms
Cardiomyopathy, Dilated / mortality,  physiopathology*,  surgery,  ultrasonography
Case-Control Studies
Child, Preschool
Echocardiography, Doppler
Heart Transplantation
Heart Ventricles / ultrasonography
Retrospective Studies
Stroke Volume / physiology
Survival Analysis
Systole / physiology
Ventricular Dysfunction, Left / physiopathology*,  ultrasonography

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