Journal of cardiovascular medicine (Hagerstown, Md.) · 2007
Prognostic value of tissue Doppler-derived ventricular asynchrony in patients with left bundle branch block but not advanced heart failure.
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Citro Rodolfo, D'Andrea Antonello, Patella Marco Mariano, Ducceschi Valentino, Provenza Gennaro, De Luca Giuseppe, Calabrò Raffaele, Gregorio Giovanni
Аннотация
OBJECTIVES: The aim of the present study was to evaluate the prognostic significance of tissue Doppler echocardiography (TDE)-derived ventricular asynchrony in patients with left bundle branch block (LBBB) but not advanced heart failure.
METHODS: Fifty-five patients (mean age 66 +/- 13 years; 33 male) with complete LBBB (QRS > 120 ms) hospitalized for an acute episode of decompensated heart failure and in New York Heart Association class II for at least 6 months before the study admission underwent standard Doppler echo and pulsed-wave TDE. Precontraction time (PCTm) from the beginning of Q wave of electrocardiogram to the onset of systolic myocardial velocity wave was evaluated in four different left ventricular (LV) basal myocardial segments (LV anterior, inferior, septal and lateral walls) and in one right ventricular (RV) lateral wall. Intraventricular activation delay (IntraV-del) was calculated by the difference of PCTm of each LV myocardial segment. Interventricular activation delay (InterV-del) was calculated by the difference of PCTm between the most delayed LV segment and RV lateral wall.
RESULTS: The mean value of EF was 40 +/- 9% and of InterV-del, IntraV-del was, respectively (97.4 +/- 46.7 and 57.9 +/- 35.5 ms). InterV-del was inversely related to EF (r = -0.68; P < 0001). During the follow-up (26 months, range 11-37 months) cardiac events were recorded in 23 (41%) patients: a worsening of heart failure (WHF) in 23 patients and cardiac death in ten patients. Cox proportional hazard multivariate analysis showed that age, and InterV-del [HR = 1.02 (P < 0.05) and 1.03 (P < 0005)] predicted mortality. A Receiver operating characteristic analysis showed that a cut-off value of InterV-del 100 ms (AUC = 0.86; P < 0001) predicted WHF and mortality with sensitivity and specificity of 75% and 90%; 81% and 84%, respectively.
CONCLUSIONS: TDE-derived interventricular asynchrony represents a prognostic indicator of major cardiac events at 2 years of follow-up in patients with LBBB but not advanced heart failure.
METHODS: Fifty-five patients (mean age 66 +/- 13 years; 33 male) with complete LBBB (QRS > 120 ms) hospitalized for an acute episode of decompensated heart failure and in New York Heart Association class II for at least 6 months before the study admission underwent standard Doppler echo and pulsed-wave TDE. Precontraction time (PCTm) from the beginning of Q wave of electrocardiogram to the onset of systolic myocardial velocity wave was evaluated in four different left ventricular (LV) basal myocardial segments (LV anterior, inferior, septal and lateral walls) and in one right ventricular (RV) lateral wall. Intraventricular activation delay (IntraV-del) was calculated by the difference of PCTm of each LV myocardial segment. Interventricular activation delay (InterV-del) was calculated by the difference of PCTm between the most delayed LV segment and RV lateral wall.
RESULTS: The mean value of EF was 40 +/- 9% and of InterV-del, IntraV-del was, respectively (97.4 +/- 46.7 and 57.9 +/- 35.5 ms). InterV-del was inversely related to EF (r = -0.68; P < 0001). During the follow-up (26 months, range 11-37 months) cardiac events were recorded in 23 (41%) patients: a worsening of heart failure (WHF) in 23 patients and cardiac death in ten patients. Cox proportional hazard multivariate analysis showed that age, and InterV-del [HR = 1.02 (P < 0.05) and 1.03 (P < 0005)] predicted mortality. A Receiver operating characteristic analysis showed that a cut-off value of InterV-del 100 ms (AUC = 0.86; P < 0001) predicted WHF and mortality with sensitivity and specificity of 75% and 90%; 81% and 84%, respectively.
CONCLUSIONS: TDE-derived interventricular asynchrony represents a prognostic indicator of major cardiac events at 2 years of follow-up in patients with LBBB but not advanced heart failure.
Предметные рубрики MeSH
Age FactorsAgedBundle-Branch BlockDisease ProgressionEchocardiography, Doppler, PulsedElectrocardiographyFemaleFollow-Up StudiesHeart Conduction SystemHeart FailureHumansKaplan-Meier EstimateMaleMiddle AgedMyocardial ContractionPredictive Value of TestsPrognosisProportional Hazards ModelsROC CurveReproducibility of ResultsResearch DesignRisk AssessmentRisk FactorsSensitivity and SpecificitySeverity of Illness IndexTime FactorsVentricular Dysfunction, Left