Prevalence of mechanical dyssynchrony in heart failure patients with different QRS durations

Background: Cardiac resynchronization therapy (CRT) has emerged as an established therapy for congestive heart failure. However, up to 30 of patients fail to respond to CRT despite prolonged QRS. Objectives: This study aimed at defining the prevalence of interventricular and intraventricular dyssynchrony in heart failure patients with different QRS durations. Methods: A total of 123 consecutive patients with severe heart failure (LVEF < 35 and NYHA class III-IV) were prospectively evaluated using 12-lead electrocardiogram and complete echocardiographic examination including tissue Doppler imaging. Results: According to the QRS duration, 56 patients had a QRS duration �120 ms (Group 1), 33 patients had a QRS duration between 120 and 150 ms (Group 2), and 34 patients had a QRS duration �150 ms (Group 3). Intraventricular dyssynchrony was present in 36 of Group 1 patients, in 58 of Group 2 patients, and in 79 of Group 3 patients (P < 0.000). Linear regression demonstrated a weak relation between QRS and intraventricular dyssynchrony. A greater proportion of patients with interventricular dyssynchrony was observed in Group 3 or Group 2 compared to patients with normal QRS duration (32 in Group 1 vs. 51.5 in Group 2 vs. 76.5 in Group 3, P < 0.000). Linear regression demonstrated a significant relation between QRS duration and interventricular mechanical delay. Conclusions: Although both interventricular and intraventricular dyssynchrony increased with the increasing QRS duration, the correlation between intraventricular mechanical and electrical dyssynchrony was weak. The lack of intraventricular dyssynchrony in a fraction of patients with standard CRT indication by QRS duration may provide us insight into the nonresponders rates. © 2007, The Authors