RESUMEN
BACKGROUND: Myocardial mechanical dyssynchrony induced by the presence of postinfarction scar and/or conduction abnormalities in patients with a left ventricular ejection fraction (LVEF) of < 35 % may be associated with a greater propensity toward inducing serious ventricular arrhythmia [(ventricular tachycardia (VT), ventricular fibrillation (VF)] and sudden cardiac death. The assessment of regional myocardial function using tissue Doppler echocardiography (TDE) allows for noninvasive analysis of regional mechanical dysfunction (LV mechanical dispersion). AIM: The aim of this study was to evaluate the TDE-based mechanical dispersion as a potential echocardiographic predictor of VT/VF. METHODS: The study group consisted of 47 consecutive ambulatory patients with implanted cardiac resynchronization therapy-defibrillator (CRT-D) devices who were divided into two groups: Group 1 (n = 29) comprised patients with recorded episodes of VT/VF, in whom baseline TDE data were available, and group 2 (n = 18) comprised patients without registered VT/VF in the device memory within 4 years after implantation. LV mechanical dispersion was defined as the standard deviation of the time measured from the beginning of the QRS complex to the peak longitudinal strain in apical four-chamber and two-chamber views. A retrospective quantitative assessment of LV regional deformation was based on the color tissue velocity recordings. RESULTS: The average time to event after implantation was 345 days. Patients with electrical events demonstrated greater mechanical dispersion: 99.14 ± 33.60 vs. 72.98 ± 19.70, p=0.002. CONCLUSION: During the 4-year follow-up, patients with documented VT/VF were characterized by significantly higher LV mechanical dispersion as compared with patients without electrical events. Measurement of LV mechanical dispersion might be helpful in determining the risk of sudden cardiac death.
Asunto(s)
Muerte Súbita Cardíaca/epidemiología , Insuficiencia Cardíaca/epidemiología , Taquicardia Ventricular/mortalidad , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/mortalidad , Fibrilación Ventricular/mortalidad , Anciano , Causalidad , Comorbilidad , Ecocardiografía/estadística & datos numéricos , Electrocardiografía/métodos , Electrocardiografía/estadística & datos numéricos , Femenino , Insuficiencia Cardíaca/diagnóstico , Humanos , Masculino , Proyectos Piloto , Polonia/epidemiología , Prevalencia , Reproducibilidad de los Resultados , Medición de Riesgo/métodos , Factores de Riesgo , Sensibilidad y Especificidad , Tasa de Supervivencia , Taquicardia Ventricular/diagnóstico , Fibrilación Ventricular/diagnósticoRESUMEN
AIMS: The study was designed to test the influence of the temporal resolution, at which tissue Doppler imaging (TDI) and speckle tracking imaging (STI) operate, on the accurate assessment of left ventricular (LV) untwist rate (UR). METHODS AND RESULTS: Echo imaging and invasive LV pressure measurements were performed during right atrial (RA) pacing and dobutamine challenge in eight pigs. LV torsion and torsional rate profiles were analysed from grey scale and tissue Doppler data (apical and basal short axis) at frame rates of 82 +/- 17 and 183 +/- 14 Hz, respectively. Temporal subsampling of TDI data sets was performed at 82 +/- 6 Hz in order to mimic the mean temporal resolution of STI and the LV torsional curves were again extracted. At rest, LV UR values were comparable for both imaging techniques. However, during dobutamine stimulation, TDI estimated peak UR was predominantly higher than UR measured by STI (-112.1 +/- 64.5 degrees /s vs. -75.5 +/- 31.4 degrees /s, P < 0.05). The similarity of LV UR measurements with respect to the STI/TDI data was examined by a Bland-Altman analysis. CONCLUSION: Although both methods regarding LV UR correlated well, these methods cannot be interchanged. STI showed a bias to underestimate UR at high values.