Coexistence and exercise exacerbation of intraleft ventricular contractile dyssynchrony in hypertensive patients with diastolic heart failure

Wang, Yi-Chih; Hwang, Juey-Jen; Lai, Ling-Ping; Tsai, Chia-Ti; Lin, Lung-Chun; Katra, Rodolphe; Lin, Jiunn-Lee

doi:10.1016/j.ahj.2007.04.008

« Previous Next »American Heart Journal
Volume 154, Issue 2 , Pages 278-284, August 2007

Coexistence and exercise exacerbation of intraleft ventricular contractile dyssynchrony in hypertensive patients with diastolic heart failure

Yi-Chih Wang, MD
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Juey-Jen Hwang, MD
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Ling-Ping Lai, MD
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Chia-Ti Tsai, MD
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Lung-Chun Lin, MD
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Rodolphe Katra, Ph
- New Therapies & Diagnostic Research, Cardiac Disease Management, Medtronic, Inc., Minneapolis, MN
Jiunn-Lee Lin, MD
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Reprint requests: Jiunn-Lee Lin, MD, No. 7, Chung-San South Rd, National Taiwan University Hospital, Taipei 100, Taiwan.

Received 8 October 2006; accepted 2 April 2007. published online 11 May 2007.

Background

Patients with heart failure (HF) and a normal left ventricular ejection fraction usually present with diastolic dysfunction (DD). Whether intraleft ventricular contractile dyssynchrony (IVCD) coexists with DD and contributes to the clinical manifestations of HF remains unclear. The study investigated the IVCD at rest and after exercise in hypertensive patients with diastolic HF (DHF).

Methods

Echocardiography was performed in 60 hypertensive patients with narrow QRS, left ventricular ejection fraction ≥50%, and no active ischemia. Patients were grouped as having DD (mitral E/A <1 plus E deceleration time >200 milliseconds, or mitral annular early diastolic velocity <8 cm/s; n = 26), DD plus HF symptoms/signs (DHF, n = 13), or as non-DD (n = 21).

Results

At rest, the IVCD index (SD of 12 left ventricular segmental electromechanical delays) was greater in the DHF and DD groups than that in the non-DD group (52.2 ± 10.7 and 39.1 ± 23.6 vs 23.1 ± 19.9 milliseconds; P < .05 for both comparisons). Six-minute treadmill exercise induced exacerbation of dyssynchrony in the DHF group (67.0 ± 12.9 vs 52.2 ± 10.7 milliseconds; P < .001). Multivariate analysis revealed that the combination of IVCD index ≥35 milliseconds at rest and ≥50 milliseconds after exercise was independently associated with DHF (odds ratio = 20, 95% CI = 2-199, P = .009). Postexercise IVCD index correlated positively with plasma N-terminal pro–brain natriuretic peptide (r = 0.37, P = .004).

Conclusions

Exercise would aggravate intraventricular dyssynchrony in hypertensive patients with DHF, implicating a potential contribution of systolic dyssynchrony to clinical manifestations.