Key result
Radial dyssynchrony assessed by cardiovascular magnetic resonance was present in 95% of patients with heart failure, including 91% of those with a QRS <120 ms.
Why the study?
Does radial dyssynchrony assessed by CMR-TSI correlate with QRS duration, LVEF, and myocardial scarring in patients with heart failure?
Observational (n=275)
Single-blind
No
Does radial dyssynchrony assessed by CMR-TSI correlate with QRS duration, LVEF, and myocardial scarring in patients with heart failure?
Absolute Event Rate: 74.8% vs 21.8%
p-value: p=<0.0001
Radial dyssynchrony assessed by CMR is nearly universal in heart failure patients regardless of QRS duration, challenging the assumption that a lack of response to CRT is primarily due to an absence of baseline dyssynchrony.
Challenges QRS-centric views of dyssynchrony in HF; leaves open its role in CRT selection pending prospective data.
BACKGROUND: Intuitively, cardiac dyssynchrony is the inevitable result of myocardial injury. We hypothesized that radial dyssynchrony reflects left ventricular remodeling, myocardial scarring, QRS duration and impaired LV function and that, accordingly, it is detectable in all patients with heart failure. METHODS: 225 patients with heart failure, grouped according to QRS duration of <120 ms (A, n = 75), between 120-149 ms (B, n = 75) or >or=150 ms (C, n = 75), and 50 healthy controls underwent assessment of radial dyssynchrony using the cardiovascular magnetic resonance tissue synchronization index (CMR-TSI = SD of time to peak inward endocardial motion in up to 60 myocardial segments). RESULTS: Compared to 50 healthy controls (21.8 +/- 6.3 ms [mean +/- SD]), CMR-TSI was higher in A (74.8 +/- 34.6 ms), B (92.4 +/- 39.5 ms) and C (104.6 +/- 45.6 ms) (all p < 0.0001). Adopting a cut-off CMR-TSI of 34.4 ms (21.8 plus 2xSD for controls) for the definition of dyssynchrony, it was present in 91% in A, 95% in B and 99% in C. Amongst patients in NYHA class III or IV, with a LVEF<35% and a QRS>120 ms, 99% had dyssynchrony. Amongst those with a QRS<120 ms, 91% had dyssynchrony. Across the study sample, CMR-TSI was related positively to left ventricular volumes (p < 0.0001) and inversely to LVEF (CMR-TSI = 178.3 e (-0.033 LVEF) ms, p < 0.0001). CONCLUSION: Radial dyssynchrony is almost universal in patients with heart failure. This vies against the notion that a lack of response to CRT is related to a lack of dyssynchrony.
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Foley et al. (2009) conducted an observational in Heart failure (n=275). Cardiovascular magnetic resonance (CMR) vs. Healthy controls was evaluated on Cardiovascular magnetic resonance tissue synchronization index (CMR-TSI) in patients with QRS <120 ms (p=<0.0001). Radial dyssynchrony assessed by cardiovascular magnetic resonance was present in 95% of patients with heart failure, including 91% of those with a QRS <120 ms.
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