[Doppler echocardiographic diagnosis of ventricular asynchrony. Present situation and future perspectives]

Heart failure is among the most common chronic diseases in the modem era. It is the major cause of morbi--mortality and hospitalization in patients aged more than 60 years. Dilatation of left ventricle frequently induces intracardiac conduction delays resulting. in asynchronous left ventricular motion. Showing as left bundle branch block in the surface EKG. Diagnosis of asynchrony based only on electrocardiogram criteria (wide QRS complex and left bundle branch block(LBBB)) proves to be non satisfactory considering the absence of parallelism between conduction unrests and cardiac dyssynchrony: 35% of LBBB are not associated with interventricular asynchrony and 20% without intraventricular asynchrony. So there is a necessity to define new criteria of asynchrony linked more directly to cardiac mechanical activity then EKG. Doppler Echocardiography brings more informative parameters concerning inter and intra ventricular asynchrony. Doppler tissue imaging can provide accurate information on electromechanical coupling and also assess interventricular and intraventricular dyssynchrony. It seems to be very promising for the prediction of the most satisfactory response to cardiac resynchronization therapy.