ISSN 1016-5169 | E-ISSN 1308-4488
Archives of the Turkish Society of Cardiology
Prognostic significance of left ventricular systolic dyssynchrony in patients with nonischemic dilated cardiomyopathy [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2009; 37(5): 301-306

Prognostic significance of left ventricular systolic dyssynchrony in patients with nonischemic dilated cardiomyopathy

Tansu Karaahmet1, Kursat Tigen1, Bulent Mutlu1, Emre Gurel1, Cihan Cevik2, Gokhan Kahveci1, Ali Cevat Tanalp1, Yelda Basaran1
1Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul
2Texas Tech University Health Sciences Center, Internal Medicine, Lubbock, TX, USA


OBJECTIVES
Left ventricular (LV) dyssynchrony parameters are still being investigated to guide and optimize treatment in heart failure. We investigated the prognostic importance of LV systolic dyssynchrony in nonischemic dilated cardiomyopathy (DCM) using tissue Doppler echocardiography.

STUDY DESIGN
The study included 62 patients (39 males, 23 females; mean age 40 years; range 9 to 77 years) with nonischemic DCM. All the patients were examined by electrocardiography, echocardiography including tissue Doppler imaging (TDI), and angiography. The patients were evaluated in two groups depending on the intraventricular delay (IVD) of ≤65 msec (group 1, 10 patients) and >65 msec (group 2, 52 patients). The primary endpoint was defined as overall mortality during a mean follow-up period of 1,253±177 days (range 943 to 1583 days).

RESULTS
Group 2 patients had a significantly longer mean IVD (129±68 msec vs. 57.5±8.7 msec; p=0.013), higher rate of left bundle branch block (30.8% vs. 10%; p=0.05), longer QRS duration (145±29 msec vs. 129±23 msec; p=0.02), and higher mortality (55.8% vs. 10%; p<0.0001). Sudden cardiac death was seen in one patient in group 1, compared to 12 patients in group 2. All the remaining deaths (n=17) occurred in group 2. In ROC analysis, the cutoff level for IVD was 65 msec for predicting clinical endpoint (specificity 72%, sensitivity 46%). Kaplan-Meier survival analysis showed a significantly lower survival in group 2 (p=0.045). In multivariate analysis, admission IVD was the only significant independent predictor of mortality (p<0.001).

CONCLUSION
Our results showed that increased IVD was associated with increased risk for death in patients with nonischemic DCM, independent from the QRS width and LV ejection fraction. These patients might be considered earlier for cardiac resynchronization therapy.

Keywords: Cardiomyopathy, dilated/mortality, echocardiography, Doppler; electrocardiography; heart conduction system; heart failure/complications; ventricular dysfunction, left/mortality.

How to cite this article
Tansu Karaahmet, Kursat Tigen, Bulent Mutlu, Emre Gurel, Cihan Cevik, Gokhan Kahveci, Ali Cevat Tanalp, Yelda Basaran. Prognostic significance of left ventricular systolic dyssynchrony in patients with nonischemic dilated cardiomyopathy. Turk Kardiyol Dern Ars. 2009; 37(5): 301-306

Corresponding Author: Cihan Cevik, United States
Manuscript Language: English


Journal Metrics

Journal Citation Indicator: 0.18
CiteScore: 1.1
Source Normalized Impact
per Paper:
0.22
SCImago Journal Rank: 0.348

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