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Dynamic ventricular dyssynchrony: an exercise-echocardiography study.

Stephane Lafitte·Pierre Bordachar·Marianne Lafitte·Stephane Garrigue·Sylvain Reuter·Patricia Reant·Karim Serri·Valerie Lebouffos·Marianne Berrhouet·Pierre Jais·Michel Haissaguerre·Jacques Clementy·Raymond Roudaut·Anthony N DeMaria
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Abstract

OBJECTIVES: We sought to assess the effects of exercise on ventricular dyssynchrony in patients with normal and depressed left ventricular (LV) function. BACKGROUND: Asynchronous myocardial contraction adversely influences ventricular function and is associated with a poor prognosis in heart failure. Exercise-induced changes in ventricular dyssynchrony may be an important determinant of dynamic changes in cardiac output and mitral regurgitation. METHODS: A total of 65 consecutive heart failure patients and 50 matched healthy control patients underwent exercise echocardiography. Conventional and tissue Doppler parameters were measured before and during symptom-limited exercise. Left ventricular dyssynchrony was defined as the standard deviation of 12 LV segmental electromechanical delays. Analysis of the control group allowed delimitation of normal cutoff values. RESULTS: In patients with normal left ventricular function, exercise did not modify the extent of LV asynchrony. In contrast, in heart failure patients, LV dyssynchrony increased by at least 20% in 34%, remained stable in 37%, and decreased by at least 20% in 29%. Moreover, 26% of heart failure patients had either exercise induction or normalization of ventricular dyssynchrony. A significant association was found between exercise-induced changes in dyssynchrony and the presence of ischemic cardiomyopathy (p < 0.05). Rest-exercise differences in ventricular dyssynchrony were correlated with changes in cardiac output and mitral regurgitation (r = -0.63 and 0.56, respectively). CONCLUSIONS: In heart failure patients, exercise can alter the magnitude of ventricular dyssynchrony. Some patients have a response to exertion with induction of ventricular dyssynchrony, whereas others show normalization. Changes in ventricular dyssynchrony during exercise correlate with alterations in cardiac output and mitral regurgitation.

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AgedCardiac Output, LowCase-Control StudiesEchocardiographyExerciseExercise TestHumansMiddle AgedMitral Valve InsufficiencyProspective StudiesReproducibility of ResultsRestVentricular Dysfunction, LeftJournal Article

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Stephane Lafitte, Pierre Bordachar, Marianne Lafitte, Stephane Garrigue, Sylvain Reuter, Patricia Reant, Karim Serri, Valerie Lebouffos, Marianne Berrhouet, Pierre Jais, Michel Haissaguerre, Jacques Clementy, Raymond Roudaut, Anthony N DeMaria. 2006-06-06. Dynamic ventricular dyssynchrony: an exercise-echocardiography study.. https://doi.org/10.1016/j.jacc.2005.11.087

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