Left ventricular mechanical dyssynchrony in acute onset cardiomyopathy

Association of its resolution with improvements in ventricular function

Hidekazu Tanaka, Masaki Tanabe, Marc A. Simon, Randall C. Starling, David Markham, Vinay Thohan, Paul Mather, Dennis M. McNamara, John Gorcsan

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objectives: The purpose of this study was to evaluate mechanical dyssynchrony in patients with acute onset cardiomyopathy with narrow QRS interval, and its association with improvements in left ventricular (LV) function. Background: LV dyssynchrony has been usually studied in patients with chronic heart failure and wide QRS in the context of cardiac resynchronization therapy. Methods: We studied 201 patients enrolled in the IMAC-2 (Inflammatory Mediators in Acute Cardiomyopathy) trial with recent onset nonischemic cardiomyopathy and ejection fraction <40%. Dyssynchrony was assessed using speckle-tracking velocity vector imaging. Diastolic function was assessed by mitral inflow E and mitral E' annular velocities (E/E'). A normal control group of 15 normal volunteers was studied for comparison. Results: Although mean QRS was narrow (98 ± 21 ms), 108 (54%) acute cardiomyopathy patients had significant LV dyssynchrony at presentation: opposing wall delay 89 ± 51 ms, versus 35 ± 11 ms in controls, and 12-site standard deviation 43 ± 23, versus 24 ± 8 ms in controls (p < 0.001). Patients with dyssynchrony had greater degrees of diastolic dysfunction: E/E' 15 ± 8 versus 12 ± 6 (p < 0.05). At 6 months, group mean ejection fraction improved from 23 ± 8% to 40 ± 12% and E/E' improved from 14 ± 7 to 9 ± 5 (both p < 0.001). Dyssynchrony improved from 89 ± 51 ms to 52 ± 35 ms in maximum opposing wall delay, and 43 ± 23 ms to 32 ± 19 ms in 12-site standard deviation, and the prevalence of dyssynchrony decreased to 12% after 6 months (p < 0.001 vs. baseline). Conclusions: Mechanical dyssynchrony was observed in a significant number of patients with acute onset cardiomyopathy, despite having a narrow QRS interval. Resolution of dyssynchrony associated with improvements in LV function occurred in the large majority of these patients.

Original languageEnglish (US)
Pages (from-to)445-456
Number of pages12
JournalJACC: Cardiovascular Imaging
Volume4
Issue number5
DOIs
StatePublished - May 2011

Fingerprint

Ventricular Function
Cardiomyopathies
Left Ventricular Function
Cardiac Resynchronization Therapy
Healthy Volunteers
Heart Failure
Control Groups

Keywords

  • acute heart failure
  • cardiomyopathy
  • dyssynchrony
  • echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Left ventricular mechanical dyssynchrony in acute onset cardiomyopathy : Association of its resolution with improvements in ventricular function. / Tanaka, Hidekazu; Tanabe, Masaki; Simon, Marc A.; Starling, Randall C.; Markham, David; Thohan, Vinay; Mather, Paul; McNamara, Dennis M.; Gorcsan, John.

In: JACC: Cardiovascular Imaging, Vol. 4, No. 5, 05.2011, p. 445-456.

Research output: Contribution to journalArticle

Tanaka, H, Tanabe, M, Simon, MA, Starling, RC, Markham, D, Thohan, V, Mather, P, McNamara, DM & Gorcsan, J 2011, 'Left ventricular mechanical dyssynchrony in acute onset cardiomyopathy: Association of its resolution with improvements in ventricular function', JACC: Cardiovascular Imaging, vol. 4, no. 5, pp. 445-456. https://doi.org/10.1016/j.jcmg.2011.02.012
Tanaka, Hidekazu ; Tanabe, Masaki ; Simon, Marc A. ; Starling, Randall C. ; Markham, David ; Thohan, Vinay ; Mather, Paul ; McNamara, Dennis M. ; Gorcsan, John. / Left ventricular mechanical dyssynchrony in acute onset cardiomyopathy : Association of its resolution with improvements in ventricular function. In: JACC: Cardiovascular Imaging. 2011 ; Vol. 4, No. 5. pp. 445-456.
@article{8269aeee0e1b4c6aa6e0cffd324820e1,
title = "Left ventricular mechanical dyssynchrony in acute onset cardiomyopathy: Association of its resolution with improvements in ventricular function",
abstract = "Objectives: The purpose of this study was to evaluate mechanical dyssynchrony in patients with acute onset cardiomyopathy with narrow QRS interval, and its association with improvements in left ventricular (LV) function. Background: LV dyssynchrony has been usually studied in patients with chronic heart failure and wide QRS in the context of cardiac resynchronization therapy. Methods: We studied 201 patients enrolled in the IMAC-2 (Inflammatory Mediators in Acute Cardiomyopathy) trial with recent onset nonischemic cardiomyopathy and ejection fraction <40{\%}. Dyssynchrony was assessed using speckle-tracking velocity vector imaging. Diastolic function was assessed by mitral inflow E and mitral E' annular velocities (E/E'). A normal control group of 15 normal volunteers was studied for comparison. Results: Although mean QRS was narrow (98 ± 21 ms), 108 (54{\%}) acute cardiomyopathy patients had significant LV dyssynchrony at presentation: opposing wall delay 89 ± 51 ms, versus 35 ± 11 ms in controls, and 12-site standard deviation 43 ± 23, versus 24 ± 8 ms in controls (p < 0.001). Patients with dyssynchrony had greater degrees of diastolic dysfunction: E/E' 15 ± 8 versus 12 ± 6 (p < 0.05). At 6 months, group mean ejection fraction improved from 23 ± 8{\%} to 40 ± 12{\%} and E/E' improved from 14 ± 7 to 9 ± 5 (both p < 0.001). Dyssynchrony improved from 89 ± 51 ms to 52 ± 35 ms in maximum opposing wall delay, and 43 ± 23 ms to 32 ± 19 ms in 12-site standard deviation, and the prevalence of dyssynchrony decreased to 12{\%} after 6 months (p < 0.001 vs. baseline). Conclusions: Mechanical dyssynchrony was observed in a significant number of patients with acute onset cardiomyopathy, despite having a narrow QRS interval. Resolution of dyssynchrony associated with improvements in LV function occurred in the large majority of these patients.",
keywords = "acute heart failure, cardiomyopathy, dyssynchrony, echocardiography",
author = "Hidekazu Tanaka and Masaki Tanabe and Simon, {Marc A.} and Starling, {Randall C.} and David Markham and Vinay Thohan and Paul Mather and McNamara, {Dennis M.} and John Gorcsan",
year = "2011",
month = "5",
doi = "10.1016/j.jcmg.2011.02.012",
language = "English (US)",
volume = "4",
pages = "445--456",
journal = "JACC: Cardiovascular Imaging",
issn = "1936-878X",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Left ventricular mechanical dyssynchrony in acute onset cardiomyopathy

T2 - Association of its resolution with improvements in ventricular function

AU - Tanaka, Hidekazu

AU - Tanabe, Masaki

AU - Simon, Marc A.

AU - Starling, Randall C.

AU - Markham, David

AU - Thohan, Vinay

AU - Mather, Paul

AU - McNamara, Dennis M.

AU - Gorcsan, John

PY - 2011/5

Y1 - 2011/5

N2 - Objectives: The purpose of this study was to evaluate mechanical dyssynchrony in patients with acute onset cardiomyopathy with narrow QRS interval, and its association with improvements in left ventricular (LV) function. Background: LV dyssynchrony has been usually studied in patients with chronic heart failure and wide QRS in the context of cardiac resynchronization therapy. Methods: We studied 201 patients enrolled in the IMAC-2 (Inflammatory Mediators in Acute Cardiomyopathy) trial with recent onset nonischemic cardiomyopathy and ejection fraction <40%. Dyssynchrony was assessed using speckle-tracking velocity vector imaging. Diastolic function was assessed by mitral inflow E and mitral E' annular velocities (E/E'). A normal control group of 15 normal volunteers was studied for comparison. Results: Although mean QRS was narrow (98 ± 21 ms), 108 (54%) acute cardiomyopathy patients had significant LV dyssynchrony at presentation: opposing wall delay 89 ± 51 ms, versus 35 ± 11 ms in controls, and 12-site standard deviation 43 ± 23, versus 24 ± 8 ms in controls (p < 0.001). Patients with dyssynchrony had greater degrees of diastolic dysfunction: E/E' 15 ± 8 versus 12 ± 6 (p < 0.05). At 6 months, group mean ejection fraction improved from 23 ± 8% to 40 ± 12% and E/E' improved from 14 ± 7 to 9 ± 5 (both p < 0.001). Dyssynchrony improved from 89 ± 51 ms to 52 ± 35 ms in maximum opposing wall delay, and 43 ± 23 ms to 32 ± 19 ms in 12-site standard deviation, and the prevalence of dyssynchrony decreased to 12% after 6 months (p < 0.001 vs. baseline). Conclusions: Mechanical dyssynchrony was observed in a significant number of patients with acute onset cardiomyopathy, despite having a narrow QRS interval. Resolution of dyssynchrony associated with improvements in LV function occurred in the large majority of these patients.

AB - Objectives: The purpose of this study was to evaluate mechanical dyssynchrony in patients with acute onset cardiomyopathy with narrow QRS interval, and its association with improvements in left ventricular (LV) function. Background: LV dyssynchrony has been usually studied in patients with chronic heart failure and wide QRS in the context of cardiac resynchronization therapy. Methods: We studied 201 patients enrolled in the IMAC-2 (Inflammatory Mediators in Acute Cardiomyopathy) trial with recent onset nonischemic cardiomyopathy and ejection fraction <40%. Dyssynchrony was assessed using speckle-tracking velocity vector imaging. Diastolic function was assessed by mitral inflow E and mitral E' annular velocities (E/E'). A normal control group of 15 normal volunteers was studied for comparison. Results: Although mean QRS was narrow (98 ± 21 ms), 108 (54%) acute cardiomyopathy patients had significant LV dyssynchrony at presentation: opposing wall delay 89 ± 51 ms, versus 35 ± 11 ms in controls, and 12-site standard deviation 43 ± 23, versus 24 ± 8 ms in controls (p < 0.001). Patients with dyssynchrony had greater degrees of diastolic dysfunction: E/E' 15 ± 8 versus 12 ± 6 (p < 0.05). At 6 months, group mean ejection fraction improved from 23 ± 8% to 40 ± 12% and E/E' improved from 14 ± 7 to 9 ± 5 (both p < 0.001). Dyssynchrony improved from 89 ± 51 ms to 52 ± 35 ms in maximum opposing wall delay, and 43 ± 23 ms to 32 ± 19 ms in 12-site standard deviation, and the prevalence of dyssynchrony decreased to 12% after 6 months (p < 0.001 vs. baseline). Conclusions: Mechanical dyssynchrony was observed in a significant number of patients with acute onset cardiomyopathy, despite having a narrow QRS interval. Resolution of dyssynchrony associated with improvements in LV function occurred in the large majority of these patients.

KW - acute heart failure

KW - cardiomyopathy

KW - dyssynchrony

KW - echocardiography

UR - http://www.scopus.com/inward/record.url?scp=79955937984&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79955937984&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2011.02.012

DO - 10.1016/j.jcmg.2011.02.012

M3 - Article

VL - 4

SP - 445

EP - 456

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

SN - 1936-878X

IS - 5

ER -