Post-systolic motion in patients with heart failure--a marker of left ventricular dyssynchrony?

The pathophysiology of post- systolic motion (PSM) is not yet fully resolved. Our aim was to study PSM in patients with heart failure (HF) and its relation to left ventricular (LV) function, brain natriuretic peptide (BNP) and to mortality.

Forty seven HF patients, mean-age 75+/-8 years with LV ejection fraction (EF) 31+/-11% were studied prospectively and compared with 10 age-matched healthy controls. Doppler Tissue Imaging data were obtained in the basal 4-chamber segments of the septal wall and PSM were measured as the ratio between velocity time integral (vti) of the positive post-systolic and systolic motion. Mean septal wall PSM was increased 0.52+/-0.41 vs controls 0.05+/-0.07 (p<0.001) and abnormal PSM (>0.18) was detected in 79% of all HF patients (92% if QRS >130 ms). Septal wall PSM correlated with QRS-duration, LV volume indices, myocardial isovolumic relaxation time (IVRT(m)) and inversely with heart rate and diastolic blood pressure, but not with BNP levels or LVEF. Only IVRT(m) correlated independently with the PSM (R(2)=0.55, p<0.001). Seventeen patients died during a mean follow-up time of 30+/-18 months. The PSM value was similar in non-survivors and survivors, 0.53+/-0.45 vs 0.52+/-0.45 (ns).

PSM is a common phenomenon in patients with HF especially in patients with wide QRS and long IVRT(m) suggesting that PSM is a manifestation of LV intra-ventricular dyssynchrony. In this study PSM did not predict mortality.