Dr. Bleeker is supported by Grant 2002B109 from the Dutch Heart Foundation. Dr. Molhoek is supported by Grant 2001D015 from the Dutch Heart Foundation.
Relationship Between QRS Duration and Left Ventricular Dyssynchrony in Patients with End-Stage Heart Failure
Article first published online: 30 APR 2004
Journal of Cardiovascular Electrophysiology
Volume 15, Issue 5, pages 544–549, May 2004
How to Cite
BLEEKER, G. B., SCHALIJ, M. J., MOLHOEK, S. G., VERWEY, H. F., HOLMAN, E. R., BOERSMA, E., STEENDIJK, P., VAN DER WALL, E. E. and BAX, J. J. (2004), Relationship Between QRS Duration and Left Ventricular Dyssynchrony in Patients with End-Stage Heart Failure. Journal of Cardiovascular Electrophysiology, 15: 544–549. doi: 10.1046/j.1540-8167.2004.03604.x
Manuscript received 4 November 2003; Accepted for publication 22 December 2003.
- Issue published online: 30 APR 2004
- Article first published online: 30 APR 2004
- heart failure;
- cardiac resynchronization therapy;
- tissue Doppler echocardiography;
- QRS duration;
- left ventricular dyssynchrony
Introduction: Patients with end-stage heart failure and a wide QRS complex are considered candidates for cardiac resynchronization therapy (CRT). However, 20% to 30% of patients do not respond to CRT. Lack of left ventricular dyssynchrony may explain the nonresponse. Accordingly, we evaluated the presence of left ventricular dyssynchrony using tissue Doppler imaging (TDI) in 90 consecutive patients with heart failure.
Methods and Results: Ninety patients with severe heart failure (left ventricular ejection fraction <35%, New York Heart Association class III–IV) were prospectively evaluated. Based on QRS duration, 30 consecutive patients with a narrow QRS complex were included (QRS duration ≤120 ms), 30 patients with an intermediate QRS duration (120–150 ms), and 30 patients with a wide QRS complex (>150 ms). All patients underwent TDI to assess left ventricular dyssynchrony. Extensive left ventricular dyssynchrony was defined as an electromechanical delay on TDI between the septum and lateral wall, the so-called septal-to-lateral delay, of >60 ms. Severe dyssynchrony was observed in 27% of patients with narrow QRS complex, 60% with intermediate QRS duration, and 70% with wide QRS complex. No relation existed between QRS duration and septal-to-lateral delay.
Conclusion: From 30% to 40% of heart failure patients with QRS duration >120 ms do not exhibit left ventricular dyssynchrony, which may explain the nonresponse to CRT. Alternatively, 27% of patients with heart failure and a narrow QRS complex show significant left ventricular dyssynchrony and may be candidates for CRT. (J Cardiovasc Electrophysiol, Vol. 15, pp. 544-549, May 2004)