Korean J Intern Med.  2010 Sep;25(3):246-252. 10.3904/kjim.2010.25.3.246.

Left Ventricular Dyssynchrony in Patients Showing Diastolic Dysfunction without Overt Symptoms of Heart Failure

• Kim JH
• Jang HS
• Bae BS
• Shin SM
• Kim KJ
• Park JG
• Kang HJ
• Lee BR
• Jung BC

• KMID: 1776604
• DOI: http://doi.org/10.3904/kjim.2010.25.3.246

Abstract

BACKGROUND/AIMS
Few studies have assessed left ventricular (LV) dyssynchrony in cases of diastolic dysfunction that do not include overt symptoms of heart failure. We hypothesized that systolic or diastolic dyssynchrony involves unique features with respect to the degree of diastolic impairment in isolated diastolic dysfunction.
METHODS
We examined 105 subjects with no history of overt symptoms of heart failure and a left ventricular ejection fraction > 50% for mechanical dyssynchrony using tissue Doppler imaging.
RESULTS
In terms of longitudinal dyssynchrony, four cases showed (6.3%) LV intraventricular systolic dyssynchrony (SDS(LV)), whereas none had LV intraventricular diastolic dyssynchrony (DDS(LV)) or co-existing systolic dyssynchrony. Radial dyssynchrony (RD) was found in six cases (9.4%). After adjusting for age, SDS(LV) and DDS(LV) were found to be significantly related to increases in the E/E' ratio (r = 0.405 and p < 0.001 vs. r = 0.216 and p = 0.045, respectively). RD at the base and apex was also significantly related to increases in E/E' (r = 0.298 and p = 0.002 vs. r = 0.196 and p = 0.045, respectively).
CONCLUSIONS
Systolic and diastolic dyssynchrony in subjects with isolated diastolic dysfunction but without overt symptoms of heart failure was not as common as in patients with diastolic heart failure; however, the systolic and diastolic intraventricular time delay increased with increases in the E/E' ratio, an indicator of diastolic dysfunction.

Keyword

Diastolic dysfunction; Dyssynchrony; E/E' ratio; Speckle tracking image

MeSH Terms

Adult
Aged
Case-Control Studies
Diastole
Echocardiography, Doppler
Female
Heart Failure, Diastolic/*physiopathology/ultrasonography
Humans
Male
Middle Aged
Systole
Ventricular Dysfunction, Left/*physiopathology/ultrasonography