https://scholars.lib.ntu.edu.tw/handle/123456789/621025
標題: | Provocation of masked left ventricular mechanical dyssynchrony by treadmill exercise in patients with systolic heart failure and narrow QRS complex | 作者: | YI-CHIH WANG HWANG, JUEY-JEN CHIH-CHIEH YU LING-PING LAI CHIA-TI TSAI Lin, Lung-Chun Katra, Rodolphe JIUNN-LEE LIN |
關鍵字: | CARDIAC RESYNCHRONIZATION THERAPY; DIASTOLIC FUNCTION; MITRAL REGURGITATION; FILLING PRESSURES; ECHOCARDIOGRAPHY; INTOLERANCE; ASYNCHRONY; INSIGHTS | 公開日期: | 1-三月-2008 | 出版社: | EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC | 卷: | 101 | 期: | 5 | 起(迄)頁: | 658 | 來源出版物: | The American journal of cardiology | 摘要: | 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 < or =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 > or =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. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/621025 | ISSN: | 0002-9149 | DOI: | 10.1016/j.amjcard.2007.10.028 |
顯示於: | 醫學系 |
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