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Effects of abnormal activation on the time course of the left ventricular pressure pulse in dilated cardiomyopathy
H B Xiao1, S J Brecker, D G Gibson
1Cardiac Department, Royal Brompton National Heart and Lung Hospital, London.
Insights
In dilated cardiomyopathy patients, prolonged QRS duration negatively impacts left ventricular pressure pulse characteristics. This affects myocardial function assessment, highlighting the need to consider QRS duration in clinical evaluations.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Echocardiography
Background:
- Dilated cardiomyopathy (DCM) is a significant cause of heart failure.
- Left ventricular (LV) pressure dynamics are crucial for assessing cardiac function.
- QRS duration on electrocardiography reflects ventricular depolarization time.
Purpose of the Study:
- To investigate the relationship between QRS duration and left ventricular pressure pulse characteristics.
- To determine how QRS duration influences the time course of functional mitral regurgitation (FMR).
Main Methods:
- Retrospective and prospective study of 50 DCM patients with FMR.
- Utilized electrocardiography, echocardiography, and continuous wave Doppler.
- Analyzed LV pressure pulse parameters derived from FMR.
Main Results:
- QRS duration positively correlated with overall FMR duration (r=0.65).
- Prolonged QRS duration lengthened contraction and relaxation times of the FMR.
- QRS duration negatively correlated with peak LV pressure rise (+dP/dt) and prolonged time to peak +dP/dt.
Conclusions:
- QRS duration is unimodally distributed in DCM patients.
- Prolonged QRS duration impairs LV systolic and diastolic function indicators.
- QRS duration is a critical factor in evaluating myocardial function in DCM.
Objective:
To investigate the effects of QRS duration on characteristics of the left ventricular pressure pulse derived from the time course of functional mitral regurgitation by continuous wave Doppler.
Design:
Retrospective and prospective study of 50 patients with dilated cardiomyopathy, by electrocardiography, echocardiography, and Doppler cardiography.
Setting:
Tertiary cardiac referral centre.
Patients:
50 patients (mean age (SD) 58 (16)) with dilated cardiomyopathy, all with functional mitral regurgitation.
Results:
The values of QRS duration ranged widely, from 70 to 190 ms with a mean value of 110 ms, and were unimodally distributed. The overall duration of mitral regurgitation correlated positively with QRS time (r = 0.65) over the entire range of values. When the duration of mitral regurgitation was divided into contraction, aortic ejection, and relaxation times, increased QRS duration prolonged contraction (r = 0.51) and relaxation (r = 0.52) times. Aortic ejection time was affected by RR interval (r = 0.74). Duration of QRS correlated negatively with peak rate of rise in left ventricular pressure (+dP/dt) (r = -0.48), and positively with the time intervals from Q to peak pressure (r = 0.49) and to peak +dP/dt (r = 0.72), and also with those from the start of mitral regurgitation to peak pressure (r = 0.49) and to peak +dP/dt (r = 0.76). Duration of QRS did not directly affect the peak rate of left ventricular pressure fall (-dP/dt), or the isovolumic relaxation period.
Conclusions:
Values of QRS duration are unimodally distributed in patients with dilated cardiomyopathy, without evidence of a discrete group of patients with left bundle branch block. Prolonged QRS duration reduces peak +dP/dt, prolongs overall duration of the pressure pulse, the time to peak +dP/dt, and relaxation time. Duration of QRS must therefore be taken into account in assessing standard measurements of myocardial function in patients with dilated cardiomyopathy.