Copyright © 2006, The European Society of Cardiology
Post-systolic motion in patients with heart failure – A marker of left ventricular dyssynchrony?
aDepartment of Clinical Sciences, Division of Internal Medicine, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
bSection of Clinical Physiology N2:01, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden
cDivision of Internal Medicicine, Ersta Hospital, Stockholm, Sweden
Received 18 April 2006; received in revised form 7 July 2006; accepted after revision 15 July 2006.
margareta.ring{at}karolinska.se
* Corresponding author. Tel.: +46 8 5177 4427; fax: +46 8 5177 3800.
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Abstract |
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Aims The pathophysiology of post- systolic motion (PSM) is not yet fully resolved. Our aim was to study PSM in patients with heart failure (HF) and its relation to left ventricular (LV) function, brain natriuretic peptide (BNP) and to mortality.
Method and results Forty- seven HF patients, mean-age 75±8years with LV ejection fraction (EF) 31±11% were studied prospectively and compared with 10 age-matched healthy controls. Doppler Tissue Imaging data were obtained in the basal 4-chamber segments of the septal wall and PSM were measured as the ratio between velocity time integral (vti) of the positive post-systolic and systolic motion. Mean septal wall PSM was increased 0.52±0.41 vs controls 0.05±0.07 (p<0.001) and abnormal PSM (>0.18) was detected in 79% of all HF patients (92% if QRS >130ms).
Septal wall PSM correlated with QRS-duration, LV volume indices, myocardial isovolumic relaxation time (IVRTm) and inversely with heart rate and diastolic blood pressure, but not with BNP levels or LVEF. Only IVRTm correlated independently with the PSM (R2=0.55, p<0.001). Seventeen patients died during a mean follow-up time of 30±18months. The PSM value was similar in non-survivors and survivors, 0.53±0.45 vs 0.52±0.45 (ns).
Conclusions PSM is a common phenomenon in patients with HF especially in patients with wide QRS and long IVRTm suggesting that PSM is a manifestation of LV intra-ventricular dyssynchrony. In this study PSM did not predict mortality.
Keywords: Heart failure; Post-systolic motion; Doppler tissue imaging
Abbreviations: LBBB, left bundle branch block • RBBB, right bundle branch block • LAH, left bundle anterolateral hemi block • ACE, angiotensin converting enzyme • E/E', early E transmitral maximal blood flow velocity/mitral e-wave measured by DTI • QRS, time of QRS duration, ms, on the electrocardiogram • PQ, time of PQ duration, ms, on the electrocardiogram • LVEDV, left ventricle end diastolic volume • LVESV, left ventricle end systolic volume • BSA, body surface area • BMI, body mass index • LVEDVi, • LVEDV/BSA, • LVESVi, • LVESV/BSA, • CRT, cardiac resynchronization therapy
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