Bi-Ventricular Myocardial Performance in Heart Failure: A New Approach to Evaluate Interventricular Dyssynchrony

Aims: Patients with heart failure (HF) exhibit ventricular dyssynchrony with negative effects on ventricular systolic and diastolic performance and poor prognosis. There is no consensus about the best approach for estimating the dyssynchrony and for selecting candidates for resynchronization therapy (CRT). We sought to evaluate whether Myocardial Performance Index (MPI), calculated as differences between left and right ventricle (LV, RV), ∆MPI, represents a marker of interventricular dyssynchrony. Methods: The study included 40 patients (22 males, 18 females, mean age 71±13) with NYHA functional class II-III, chronic heart failure (77% ischaemic), in optimal drug therapy for at least three months. All patients underwent a complete two-dimensional and Tissue Doppler Echocardiography (TDE), including an assessment of MPI in both ventricles. Results: Significant correlations were found between ∆MPI and QRS (r = 0.41, p < 0.001), with NYHA (r = 0.66, p < 0.001), with SPWMD (r = 0.32, p < 0.05), with LV ejection fraction (r = -0.32, p < 0.05), with Spv wave at the septal site of LV (r = -0.32, p < 0.05), and with IVMD (r = 0.44, p < 0.001). Ten patients have been re-evaluated six months after CRT implantation, and ∆MPI significantly correlated with the difference between basal LVEF and six months after CRT implantation (r = 0.43, p < 0.04). Conclusion: The ∆MPI could represent an integrative marker of interventricular dyssynchrony and could be considered as a new parameter in the patient selection process to be undergone CRT.