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Diastolic and systolic asynchrony in patients with diastolic heart failure: a common but ignored condition
Cheuk-Man Yu1, Qing Zhang, Gabriel W K Yip
1Li Ka Shing Institute of Health Sciences, S.H. Ho Cardiovascular and Stroke Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, People's Republic of China. cmyu@cuhk.edu.hk
Insights
Diastolic and systolic asynchrony are common in diastolic heart failure (DHF) patients, even with normal QRS duration. These mechanical dysfunctions appear to have distinct underlying mechanisms.
Area of Science:
- Cardiology
- Cardiac Physiology
- Echocardiography
Background:
- Mechanical asynchrony data in diastolic heart failure (DHF) is limited.
- Understanding asynchrony in DHF is crucial for differentiating it from systolic heart failure (SHF).
Purpose of the Study:
- To investigate the presence, prevalence, and relationship of diastolic and systolic asynchrony in patients with DHF.
- To compare mechanical asynchrony between DHF and SHF patients.
Main Methods:
- Tissue Doppler echocardiography was used to assess diastolic and systolic asynchrony in 373 heart failure patients (92 DHF, 281 SHF) and 100 controls.
- Standard deviation of time to peak myocardial systolic (Ts-SD) and early diastolic (Te-SD) velocities were measured to quantify asynchrony.
Main Results:
- Both DHF and SHF groups exhibited prolonged Te-SD and Ts-SD compared to controls (p < 0.001).
- Diastolic asynchrony prevalence was similar between DHF and SHF (35.9% vs. 43.1%), but systolic asynchrony was less common in DHF (39.1% vs. 56.9%; p = 0.003).
- A significant proportion of DHF patients (61%) showed some form of asynchrony, often with narrow QRS duration (10.9% vs. 37.7% in SHF; p < 0.001).
Conclusions:
- Diastolic and/or systolic asynchrony is prevalent in DHF patients, irrespective of QRS duration.
- The study suggests that systolic and diastolic asynchrony in DHF may arise from distinct mechanisms.
- Asynchrony was not found to be directly related to myocardial systolic or diastolic function in DHF patients.
Objectives:
The present study aimed to examine whether diastolic and systolic asynchrony exist in diastolic heart failure (DHF) and their prevalence and relationship to systolic heart failure (SHF) patients.
Background:
Few data exist on mechanical asynchrony in DHF.
Methods:
Tissue Doppler echocardiography was performed in 373 heart failure patients (281 with SHF and 92 with DHF) and 100 normal subjects. Diastolic and systolic asynchrony was determined by measuring the standard deviation of time to peak myocardial systolic (Ts-SD) and peak early diastolic (Te-SD) velocity using a 6-basal, 6-mid-segmental model, respectively.
Results:
Both heart failure groups had prolonged Te-SD (DHF vs. SHF vs. controls subjects: 32.2 +/- 18.0 ms vs. 38.0 +/- 25.2 ms vs. 19.5 +/- 7.1 ms) and Ts-SD (31.8 +/- 17.0 ms vs. 36.7 +/- 15.2 ms vs. 17.6 +/- 7.9 ms) compared with the control group (all p < 0.001 vs. control subjects). Based on normal values, the DHF group had comparable diastolic (35.9% vs. 43.1%; chi-square = 1.48, p = NS), but less systolic asynchrony than the SHF group (39.1% vs. 56.9%; chi-square = 8.82, p = 0.003). Normal synchrony, isolated systolic, isolated diastolic, and combined asynchrony were observed in 39.1%, 25.0%, 21.7%, and 14.1% of DHF patients, respectively, and these were 25.6%, 31.3%, 17.4%, and 25.6%, correspondingly, in SHF (chi-square = 10.01, p = 0.019). The correlation between systolic and diastolic asynchrony, and between the myocardial velocities and corresponding mechanical asynchrony appeared weak. A wide QRS duration (>120 ms) was rare in DHF (10.9% vs. 37.7% in SHF) (chi-square = 16.69, p < 0.001).
Conclusions:
Diastolic and/or systolic asynchrony was common in 61% of DHF patients despite narrow QRS complex. The presence of asynchrony was not related to myocardial systolic or diastolic function. Systolic and diastolic asynchrony were not tightly coupled, implying distinct mechanisms.
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