Provocation of Masked Left Ventricular Mechanical Dyssynchrony by Treadmill Exercise in Patients With Systolic Heart Failure and Narrow QRS Complex

Yi Chih Wang, Juey Jen Hwang, Chih Chieh Yu, Ling Ping Lai, Chia Ti Tsai, Lung Chun Lin, Rodolphe Katra, Jiunn Lee Lin

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Tissue Doppler imaging-derived intra-left ventricular (LV) contractile dyssynchrony is an evolving prognostic parameter for patients with systolic heart failure (HF). However, whether and how exercise could abolish the synchronicity in HF patients with narrow QRS remains less studied. We evaluated a total of 33 HF patients with impaired LV ejection fraction (<50%), QRS duration ≤120 ms, and baseline dyssynchrony index (DI; standard deviation of electromechanical delay of 12 LV segments by tissue Doppler imaging) <33 ms. After a 6-minute treadmill exercise by modified Bruce protocol, the absolute time difference from QRS onset to peak systolic myocardial velocity of each segment was recorded immediately. With similar DI at rest and peak heart rates during exercise, 11 patients (33%) developed dyssynchrony (DI ≥33 ms) after exercise, and the others did not (44.7 ± 8.0 vs 16.2 ± 8.3 ms, p <0.001). Patients with dyssynchrony after exercise had greater baseline mitral early diastolic velocity/annular early diastolic velocity (E/Ea) (19 ± 17 vs 10 ± 5, p <0.026). Multivariate analysis revealed mitral E/Ea >10 at rest, indicating higher LV filling pressure, independently predicted the exercise-evoked dyssynchrony (odds ratio 18, 95% confidence interval 2 to 163, p <0.012). In conclusion, exercise uncovered masked LV dyssynchrony in 1/3 of systolic HF patients with narrow QRS, and exercise-provoked dyssynchrony could be predicted by mitral E/Ea >10 at rest.

Original languageEnglish
Pages (from-to)658-661
Number of pages4
JournalAmerican Journal of Cardiology
Volume101
Issue number5
DOIs
Publication statusPublished - Mar 1 2008
Externally publishedYes

Fingerprint

Systolic Heart Failure
Exercise
Heart Failure
Ventricular Pressure
Stroke Volume
Odds Ratio
Confidence Intervals

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Provocation of Masked Left Ventricular Mechanical Dyssynchrony by Treadmill Exercise in Patients With Systolic Heart Failure and Narrow QRS Complex. / Wang, Yi Chih; Hwang, Juey Jen; Yu, Chih Chieh; Lai, Ling Ping; Tsai, Chia Ti; Lin, Lung Chun; Katra, Rodolphe; Lin, Jiunn Lee.

In: American Journal of Cardiology, Vol. 101, No. 5, 01.03.2008, p. 658-661.

Research output: Contribution to journalArticle

Wang, Yi Chih ; Hwang, Juey Jen ; Yu, Chih Chieh ; Lai, Ling Ping ; Tsai, Chia Ti ; Lin, Lung Chun ; Katra, Rodolphe ; Lin, Jiunn Lee. / Provocation of Masked Left Ventricular Mechanical Dyssynchrony by Treadmill Exercise in Patients With Systolic Heart Failure and Narrow QRS Complex. In: American Journal of Cardiology. 2008 ; Vol. 101, No. 5. pp. 658-661.
@article{b6fd48f38f68460187d3790ceb34591f,
title = "Provocation of Masked Left Ventricular Mechanical Dyssynchrony by Treadmill Exercise in Patients With Systolic Heart Failure and Narrow QRS Complex",
abstract = "Tissue Doppler imaging-derived intra-left ventricular (LV) contractile dyssynchrony is an evolving prognostic parameter for patients with systolic heart failure (HF). However, whether and how exercise could abolish the synchronicity in HF patients with narrow QRS remains less studied. We evaluated a total of 33 HF patients with impaired LV ejection fraction (<50{\%}), QRS duration ≤120 ms, and baseline dyssynchrony index (DI; standard deviation of electromechanical delay of 12 LV segments by tissue Doppler imaging) <33 ms. After a 6-minute treadmill exercise by modified Bruce protocol, the absolute time difference from QRS onset to peak systolic myocardial velocity of each segment was recorded immediately. With similar DI at rest and peak heart rates during exercise, 11 patients (33{\%}) developed dyssynchrony (DI ≥33 ms) after exercise, and the others did not (44.7 ± 8.0 vs 16.2 ± 8.3 ms, p <0.001). Patients with dyssynchrony after exercise had greater baseline mitral early diastolic velocity/annular early diastolic velocity (E/Ea) (19 ± 17 vs 10 ± 5, p <0.026). Multivariate analysis revealed mitral E/Ea >10 at rest, indicating higher LV filling pressure, independently predicted the exercise-evoked dyssynchrony (odds ratio 18, 95{\%} confidence interval 2 to 163, p <0.012). In conclusion, exercise uncovered masked LV dyssynchrony in 1/3 of systolic HF patients with narrow QRS, and exercise-provoked dyssynchrony could be predicted by mitral E/Ea >10 at rest.",
author = "Wang, {Yi Chih} and Hwang, {Juey Jen} and Yu, {Chih Chieh} and Lai, {Ling Ping} and Tsai, {Chia Ti} and Lin, {Lung Chun} and Rodolphe Katra and Lin, {Jiunn Lee}",
year = "2008",
month = "3",
day = "1",
doi = "10.1016/j.amjcard.2007.10.028",
language = "English",
volume = "101",
pages = "658--661",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Provocation of Masked Left Ventricular Mechanical Dyssynchrony by Treadmill Exercise in Patients With Systolic Heart Failure and Narrow QRS Complex

AU - Wang, Yi Chih

AU - Hwang, Juey Jen

AU - Yu, Chih Chieh

AU - Lai, Ling Ping

AU - Tsai, Chia Ti

AU - Lin, Lung Chun

AU - Katra, Rodolphe

AU - Lin, Jiunn Lee

PY - 2008/3/1

Y1 - 2008/3/1

N2 - Tissue Doppler imaging-derived intra-left ventricular (LV) contractile dyssynchrony is an evolving prognostic parameter for patients with systolic heart failure (HF). However, whether and how exercise could abolish the synchronicity in HF patients with narrow QRS remains less studied. We evaluated a total of 33 HF patients with impaired LV ejection fraction (<50%), QRS duration ≤120 ms, and baseline dyssynchrony index (DI; standard deviation of electromechanical delay of 12 LV segments by tissue Doppler imaging) <33 ms. After a 6-minute treadmill exercise by modified Bruce protocol, the absolute time difference from QRS onset to peak systolic myocardial velocity of each segment was recorded immediately. With similar DI at rest and peak heart rates during exercise, 11 patients (33%) developed dyssynchrony (DI ≥33 ms) after exercise, and the others did not (44.7 ± 8.0 vs 16.2 ± 8.3 ms, p <0.001). Patients with dyssynchrony after exercise had greater baseline mitral early diastolic velocity/annular early diastolic velocity (E/Ea) (19 ± 17 vs 10 ± 5, p <0.026). Multivariate analysis revealed mitral E/Ea >10 at rest, indicating higher LV filling pressure, independently predicted the exercise-evoked dyssynchrony (odds ratio 18, 95% confidence interval 2 to 163, p <0.012). In conclusion, exercise uncovered masked LV dyssynchrony in 1/3 of systolic HF patients with narrow QRS, and exercise-provoked dyssynchrony could be predicted by mitral E/Ea >10 at rest.

AB - Tissue Doppler imaging-derived intra-left ventricular (LV) contractile dyssynchrony is an evolving prognostic parameter for patients with systolic heart failure (HF). However, whether and how exercise could abolish the synchronicity in HF patients with narrow QRS remains less studied. We evaluated a total of 33 HF patients with impaired LV ejection fraction (<50%), QRS duration ≤120 ms, and baseline dyssynchrony index (DI; standard deviation of electromechanical delay of 12 LV segments by tissue Doppler imaging) <33 ms. After a 6-minute treadmill exercise by modified Bruce protocol, the absolute time difference from QRS onset to peak systolic myocardial velocity of each segment was recorded immediately. With similar DI at rest and peak heart rates during exercise, 11 patients (33%) developed dyssynchrony (DI ≥33 ms) after exercise, and the others did not (44.7 ± 8.0 vs 16.2 ± 8.3 ms, p <0.001). Patients with dyssynchrony after exercise had greater baseline mitral early diastolic velocity/annular early diastolic velocity (E/Ea) (19 ± 17 vs 10 ± 5, p <0.026). Multivariate analysis revealed mitral E/Ea >10 at rest, indicating higher LV filling pressure, independently predicted the exercise-evoked dyssynchrony (odds ratio 18, 95% confidence interval 2 to 163, p <0.012). In conclusion, exercise uncovered masked LV dyssynchrony in 1/3 of systolic HF patients with narrow QRS, and exercise-provoked dyssynchrony could be predicted by mitral E/Ea >10 at rest.

UR - http://www.scopus.com/inward/record.url?scp=41949099343&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=41949099343&partnerID=8YFLogxK

U2 - 10.1016/j.amjcard.2007.10.028

DO - 10.1016/j.amjcard.2007.10.028

M3 - Article

C2 - 18308016

AN - SCOPUS:41949099343

VL - 101

SP - 658

EP - 661

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 5

ER -