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The impact of exercise-induced changes in intraventricular dyssynchrony on functional improvement in patients with nonischemic cardiomyopathy.

Authors
Kang, SJ; Lim, HS; Choi, BJ; Choi, SY; Yoon, MH; Hwang, GS; Shin, JH; Tahk, SJ
Citation
Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography, 21(8):948-953, 2008
Journal Title
Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
ISSN
0894-73171097-6795
Abstract
BACKGROUND: The assessment of dynamic intraventricular dyssynchrony has been reported to be feasible in a clinical setting. However, its prognostic implication in functional improvement has not yet been investigated.



METHODS: Symptom-limited, supine bicycle exercise was performed on 41 patients with nonischemic cardiomyopathy (52 +/- 12 years, ejection fraction < 40%). Using Doppler tissue imaging, the average of peak systolic velocities at 6 basal segments was obtained at rest and peak exercise. Dyssynchrony index (Ts-SD12) was defined as the SD of the time to peak systolic velocities at 12 left ventricular segments. The percent change of end-systolic volume (%Delta ESV) was calculated at follow-up. A 15% or greater reduction in end-systolic volume (%Delta ESV < -15%) was considered as functional improvement.



RESULTS: During exercise, changes in dyssynchrony (Delta Ts-SD12) were individually variable. Average of peak systolic velocities (V) at 6 basal segments at peak exercise independently correlated with Ts-SD12 at peak exercise (beta = -0.541, P < .001). Follow-up echocardiography was performed on 35 patients after medical treatment for 13.0 +/- 4.9 months. There was significant association of %Delta ESV with the change in mitral regurgitation (r = 0.434, P = .009), disease duration (r = 0.343, P = .045), QRS interval (r = 0.347, P = .041), and Delta Ts-SD12 (r = 0.511, P = .002). Multivariate analysis identified Ts-SD12 measured at peak exercise as the strongest predictor for functional improvement (%Delta ESV: beta = 0.577, P < .001; and Delta ejection fraction: beta = -0.563, P < .001).



CONCLUSION: In patients with heart failure, dynamic dyssynchrony can be assessed during exercise. Ts-SD12 at peak exercise may be an independent predictor for reverse remodeling with medical treatment.
MeSH terms
Cardiomyopathies/ultrasonography*Echocardiography, Doppler/methods*Exercise Test/methods*FemaleHumansMaleMiddle AgedMyocardial Ischemia/ultrasonographyReproducibility of ResultsSensitivity and SpecificityVentricular Dysfunction, Left/ultrasonography*
DOI
10.1016/j.echo.2008.01.009
PMID
18325737
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Cardiology
AJOU Authors
강, 수진임, 홍석최, 병주최, 소연윤, 명호황, 교승신, 준한탁, 승제
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