Institute of Cardiovascular Diseases, Timisoara, Romania
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The aim of this study was to evaluate the influence of cardiac dyssynchrony on 2D-strain parameters in patients with non-ischemic heart failure with reduced ejection fraction (NIHF).Methods: Standard echocardiogram was performed in 96 consecutive patients with NIHF, in sinusal rhythm. Time to peak systolic velocity (Ts) was measured from the beginning of the QRS complex to the peak myocardial systolic velocity using pulsed tissue Doppler imaging. Absolute difference in Ts between any two of the four basal (septal, lateral, inferior, and anterior) left ventricular (LV) wall segments, absolute difference in Ts between any two of the six basal LV segments, absolute difference in Ts between any 2 of the 12 basal and mid LV segments, and standard deviation of Ts of the 12 basal and mid LV segments were determined as validated dyssynchrony parameters (≥65 ms, ≥110 ms, ≥100 ms and ≥32.6 ms, respectively). Cardiac dyssynchrony was defined in the presence of minimum three of the above dyssynchrony parameters. LV strain, twist and torsion were determined using 2D-strain imaging. Patients were divided into three groups: group 1 including 53 patients without left bundle branch-block (LBBB)/dyssynchrony, group 2 including 17 patients with LBBB but without dyssynchrony, and group 3 including 26 patients with cardiac dyssynchrony.Results: LV ejection fraction, strain, torsion and twist were significantly different in group 1 compared to group 2 and 3 (figure 1). In group 3, LV torsion and twist were significantly lower (p=0.03 and p=0.001, respectively) and LV strain was significantly higher (p<0.001) compared to group 2, but LV ejection fraction was not different (p=0.89).Conclusion: In patients with NIHF, the presence of cardiac dyssynchrony induces a significant reduction of LV strain, torsion and twist.