TY - JOUR
T1 - Left Ventricular Dyssynchrony in Patients with Normal Ventricular Systolic Function Referred for Exercise Echocardiography
AU - Bernheim, Alain M.
AU - Nakajima, Yoshie
AU - Pellikka, Patricia A.
N1 - Funding Information:
Grant information: Dr. AM Bernheim was supported by grants from the Swiss National Science Foundation Zurich, Switzerland and the Freiwillige Akademische Gesellschaft Basel, Switzerland. The study was supported by a grant from the Mayo Foundation.
PY - 2008/10
Y1 - 2008/10
N2 - Background: Exercise testing is often normal despite the presence of exertional symptoms. We hypothesized that left ventricular (LV) dyssynchrony might occur in some patients in the absence of ischemia, LV dysfunction, or wide QRS, and might contribute to exertional symptoms and diminished exercise capacity. Methods: Echocardiographic parameters were assessed before and with exercise in 40 patients (age 62 ± 8 years, 27 with exertional symptoms). All had normal clinically indicated exercise echocardiograms and narrow QRS. The time to peak systolic velocity (Ts) was measured in 12 segments to calculate the standard deviation (Ts-SD) and the maximal difference (Ts-diff). Results: At rest, 25 patients (63%) had dyssynchrony by Ts-SD. With exercise, mean Ts-SD did not increase significantly (34.9 ± 19.3 ms vs 39.5 ± 27.2 ms, P = .28). However, Ts-SD increased by greater than 40% in 15 patients (37.5%), remained stable in 19 patients (47.5%), and decreased by greater than 40% in 6 patients (15%). Similar responses were observed for Ts-diff. Patients with exercise-induced dyssynchrony were not more likely to have symptoms. Exercise capacity was inversely correlated with resting Ts-SD (r = -0.37, P = .02) and resting Ts-diff (r = -0.38, P = .02), but not with exercise-induced changes in dyssynchrony. Patients with resting dyssynchrony had higher resting heart rate (73 ± 12 vs 63 ± 11 beats/min, P = .02). Conclusion: LV dyssynchrony may occur more frequently than previously thought and may develop with exercise in the absence of ischemia. Exercise-induced LV dyssynchrony was not related to exertional symptoms or exercise capacity. Patients with dyssynchrony at rest had a higher resting heart rate and achieved a lower workload; this may indicate early myocardial impairment.
AB - Background: Exercise testing is often normal despite the presence of exertional symptoms. We hypothesized that left ventricular (LV) dyssynchrony might occur in some patients in the absence of ischemia, LV dysfunction, or wide QRS, and might contribute to exertional symptoms and diminished exercise capacity. Methods: Echocardiographic parameters were assessed before and with exercise in 40 patients (age 62 ± 8 years, 27 with exertional symptoms). All had normal clinically indicated exercise echocardiograms and narrow QRS. The time to peak systolic velocity (Ts) was measured in 12 segments to calculate the standard deviation (Ts-SD) and the maximal difference (Ts-diff). Results: At rest, 25 patients (63%) had dyssynchrony by Ts-SD. With exercise, mean Ts-SD did not increase significantly (34.9 ± 19.3 ms vs 39.5 ± 27.2 ms, P = .28). However, Ts-SD increased by greater than 40% in 15 patients (37.5%), remained stable in 19 patients (47.5%), and decreased by greater than 40% in 6 patients (15%). Similar responses were observed for Ts-diff. Patients with exercise-induced dyssynchrony were not more likely to have symptoms. Exercise capacity was inversely correlated with resting Ts-SD (r = -0.37, P = .02) and resting Ts-diff (r = -0.38, P = .02), but not with exercise-induced changes in dyssynchrony. Patients with resting dyssynchrony had higher resting heart rate (73 ± 12 vs 63 ± 11 beats/min, P = .02). Conclusion: LV dyssynchrony may occur more frequently than previously thought and may develop with exercise in the absence of ischemia. Exercise-induced LV dyssynchrony was not related to exertional symptoms or exercise capacity. Patients with dyssynchrony at rest had a higher resting heart rate and achieved a lower workload; this may indicate early myocardial impairment.
KW - Doppler
KW - Echocardiography
KW - Exercise testing
KW - Tissue Doppler
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U2 - 10.1016/j.echo.2008.08.002
DO - 10.1016/j.echo.2008.08.002
M3 - Article
C2 - 18926390
AN - SCOPUS:52949150129
SN - 0894-7317
VL - 21
SP - 1145
EP - 1149
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 10
ER -