ABSTRACT
Echocardiographic parameters of mechanical dyssynchrony may improve patients selection for cardiac resynchronisation therapy in chronic heart failure. This study aimed to define the prevalence of inter, intra and atrio-ventricular dyssynchrony in heart failure patients with different QRS duration and to evaluate inter and intra-observer variability in collecting different echocardiographic dyssynchony parameters. Twenty patients with chronic heart failure of any origin, NYHA functional class II-III with LVEF < 40%, were evaluated by complete echocardiographic examination including tissue Doppler imaging [DTI] and Tissue Tracking. Three patients had an atrio-ventricular dyssynchrony with a mean left ventricular filling time to cardiac cycle of 33 +/- 5%. Six patients had an interventricular mechanical delay [IVMD] > 40 milliseconds, all of them had a QRS duration >/= 120 milliseconds. Overall, no statistically significant correlation was found between IVMD and QRS duration [r=0.35, p=0.4]. The mean septal to posterior wall-motion delay [SPWMD] was 83 +/- 64 ms. 7 patients had SPWMD >/= 130 ms. The baseline QRS duration did not correlate with SPWMD [p=0.7]. The mean LV dyssynchrony determined by deltaS-peak was 74 +/- 42 ms. Seven patients had LV dyssynchrony. Linear regression did not demonstrate a relation between QRS width and intraventricular dyssynchrony [p=0.34]. There was no concordance between intra-ventricular spatial or longitudinal dyssynchrony determined by DTI method and by Tissue Tracking [p=0.3 and 0.6 respectively]. The intraobserver reproducibility of LVFT/RR, IVMD and deltaS-peak [ICC= 0.99, 0.98 and 0.99, respectively], as well as the interobserver reproducibility [ICC: 0.96, 0.94 and 0.92, respectively], were very high. However, we observed a high variability for SPWMD measure [ICC=0.27, p=0.31]. Mechanical dyssynchrony did not correlate with QRS duration, despite the poor variability in collecting different echocardiographie parameters
Subject(s)
Humans , Echocardiography, Doppler , Heart Failure/diagnostic imaging , Prevalence , Observer VariationABSTRACT
Classic echocardiographic methods to estimate mitral valve area [MVA] in the mitral stenosis [MS] has several limitations. Recently, the proximal isovelocity surface area [NSA] method has been shown lobe accurate for calculating MVA. This study sought to I] compare the accuracy of the PISA method to planimetry and Doppler pressure half-time [PHT] methods for echocardiographic estimation of MVA and 2] to evaluate the effect of atrial fibrillation [AF] and significant mitral regorgit4tjon [MR] on the accuracy of the NSA method. In 35 patients with rhumatic mitral stenosis, the mitral valve areas were determined by two-dimensional echocardiographic planimetry, pressure half-time and proximal flow convergence region. 19 patients had atrial fibrillation and 15 had associated mitral insufficiency a 2. The correlaton between PISA and planimetry areas was significant [r=0.83, p<.001]. The intraclass correlation coefficient was of 0.85 but with a large confidence interval [IC95%[0,68-0,91] explaining the significant underestimation of MVA by PISA method: 1,42 +/- 0,47 cm2 versus 1,56 +/- 0,41 cm2 respectively, [p<.001]-There was no signicant difference between PISA and PHT areas 1,42 +/- 0,47 cm2 versus I .43 +/- 0,46 cm. Underestimation of MVA par PISA method didn't have real clinical implication: the sensibility of diagnosing severe MS [MVA -1.5 cm[2]] was 90%vith a negative predictive value of 83%. The correlation was good in patients with AF[r=0,84, p<.001] and with significant MR [r=0,83, p<.001]. The PISA method may be considered as reliable alternative method for estimation of the MVA in MS. Its accuracy is good in AF and associated MR