Turk Kardiyol Dern Ars. 2007; 35(7): 417-422

QRS duration is closely related to echocardiographic parameters in patients with ischemic mitral regurgitation

Nurten Sayar, Nazmiye Çakmak, Ahmet Lütfullah Orhan, Hale Yılmaz, Hüsnü Atmaca, Zekeriya Nurkalem, Mehmet Ergelen, Burak Tangürek, Hakan Hasdemir, Hüseyin Aksu, Ahmet Taha Alper, Mehmet Eren
Department Of Cardiology, Siyami Ersek Cardiovascular Research And Training Hospital, Istanbul, Turkey.

OBJECTIVES
Prolonged QRS duration is associated with mechanical dyssynchrony. Ischemic mitral regurgitation (MR) results from geometric changes in left ventricular (LV) shape, which also causes mechanical dyssynchrony. The aim of this study was to define the correlation of QRS duration with echocardiographic parameters reflecting LV function, shape, and mitral deformation in patients with ischemic MR.

STUDY DESIGN
The study included 29 patients (19 males, 10 females; mean age 64±3 years) who had at least moderate ischemic MR and a history of myocardial infarction or coronary revascularization. All the patients underwent echocardiography where LV ejection fraction, LV volumes, effective regurgitant orifice, tethering distance, tethering area, end-systolic sphericity index, and pulmonary artery pressures were measured. The patients were assessed in two groups formed based on the cutoff value of 120 ms for QRS duration.

RESULTS
The mean MR severity was 2.8±0.8. QRS duration was <120 ms in 19 patients, and ≥120 in 10 patients. Prolonged QRS duration (≥120 ms) was accompanied by significantly lower LV ejection fraction and higher LV volumes and mitral valve deformation indices. QRS duration was in correlation with the following: LV ejection fraction (r=-0.62, p<0.001), LV end-systolic volume index (r=0.58, p<0.0001), LV end-diastolic volume index (r=0.46, p=0.014), vena contracta (r=0.37, p=0.016), mitral annulus diameter (r=0.42, p=0.004), tethering distance (r=0.43, p=0.005), tethering area (r=0.44, p=0.003), and end-systolic sphericity index (r=-0.39, p=0.01). Multiple regression analysis showed that LV ejection fraction was the only independent variable affecting QRS duration (ß= -1.1, p=0.025).

CONCLUSION
QRS duration is closely correlated with LV systolic functions and geometry and mitral apparatus deformation in patients with ischemic MR.

Keywords: Echocardiography, electrocardiography, heart conduction system; mitral valve insufficiency/diagnosis; myocardial ischemia; ventricular dysfunction, left/diagnosis

---

CITE