Document Detail


Provocation of masked left ventricular mechanical dyssynchrony by treadmill exercise in patients with systolic heart failure and narrow QRS complex.
MedLine Citation:
PMID:  18308016     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Tissue Doppler imaging-derived intra-left ventricular (LV) contractile dyssynchrony is an evolving prognostic parameter for patients with systolic heart failure (HF). However, whether and how exercise could abolish the synchronicity in HF patients with narrow QRS remains less studied. We evaluated a total of 33 HF patients with impaired LV ejection fraction (<50%), QRS duration < or =120 ms, and baseline dyssynchrony index (DI; standard deviation of electromechanical delay of 12 LV segments by tissue Doppler imaging) <33 ms. After a 6-minute treadmill exercise by modified Bruce protocol, the absolute time difference from QRS onset to peak systolic myocardial velocity of each segment was recorded immediately. With similar DI at rest and peak heart rates during exercise, 11 patients (33%) developed dyssynchrony (DI > or =33 ms) after exercise, and the others did not (44.7 +/- 8.0 vs 16.2 +/- 8.3 ms, p <0.001). Patients with dyssynchrony after exercise had greater baseline mitral early diastolic velocity/annular early diastolic velocity (E/Ea) (19 +/- 17 vs 10 +/- 5, p <0.026). Multivariate analysis revealed mitral E/Ea >10 at rest, indicating higher LV filling pressure, independently predicted the exercise-evoked dyssynchrony (odds ratio 18, 95% confidence interval 2 to 163, p <0.012). In conclusion, exercise uncovered masked LV dyssynchrony in 1/3 of systolic HF patients with narrow QRS, and exercise-provoked dyssynchrony could be predicted by mitral E/Ea >10 at rest.
Authors:
Yi-Chih Wang; Juey-Jen Hwang; Chih-Chieh Yu; Ling-Ping Lai; Chia-Ti Tsai; Lung-Chun Lin; Rodolphe Katra; Jiunn-Lee Lin
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Publication Detail:
Type:  Journal Article     Date:  2008-01-15
Journal Detail:
Title:  The American journal of cardiology     Volume:  101     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-02-29     Completed Date:  2008-04-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  658-61     Citation Subset:  AIM; IM    
Affiliation:
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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MeSH Terms
Descriptor/Qualifier:
Blood Flow Velocity / physiology
Coronary Circulation / physiology
Diastole / physiology
Electrocardiography*
Exercise Test*
Female
Heart Atria / physiopathology,  ultrasonography
Heart Failure, Systolic / physiopathology*
Heart Ventricles / ultrasonography
Humans
Male
Middle Aged
Mitral Valve / physiopathology
Multivariate Analysis
Stroke Volume / physiology
Ventricular Dysfunction, Left / diagnosis*,  physiopathology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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