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Left ventricular dyssynchrony in patients with heart failure: pathophysiology, diagnosis and treatment

Nature Clinical Practice Cardiovascular Medicine volume 3, pages 213–219 (2006)Cite this article

Abstract

The number of patients with chronic heart failure is increasing rapidly in the Western world. Despite the introduction of new pharmacologic therapies, the prognosis of these patients remains poor. Left ventricular (LV) dyssynchrony is a frequently observed feature in patients with heart failure, and is recognized as an important predictor of poor outcome if left untreated. The presence of LV dyssynchrony leads to inefficient LV contraction with a decreased cardiac output. Moreover, patients with LV dyssynchrony are at increased risk of adverse cardiac events. New therapeutic options targeted at restoring normal mechanical synchrony, such as cardiac resynchronization therapy, have been shown to improve clinical symptoms and prognosis in patients with heart failure. The beneficial effects of cardiac resynchronization therapy are predominantly mediated by this treatment's ability to reduce LV dyssynchrony. Given these results, adequate identification of LV dyssynchrony in patients with heart failure is of paramount importance. Several new imaging techniques are proving useful for diagnosis of LV dyssynchrony. In particular, advanced echocardiographic techniques (e.g. tissue Doppler imaging) and conductance catheter techniques are two accurate methods for quantification of LV dyssynchrony. In this review, we discuss the pathophysiology, diagnosis and treatment of LV dyssynchrony in patients with heart failure.

Key Points

  • Various types of dyssynchronous activation are seen in heart failure, such as atrioventricular dyssynchrony, interventricular dyssynchrony and left intraventricular dyssynchrony

  • Left ventricular (LV) dyssynchrony in heart failure patients results in ineffective LV systolic function and worsens prognosis

  • Promising results in patients with drug-refractory heart failure are reviving interest in the possible use of cardiac resynchronization therapy for LV dyssynchrony reduction

  • LV dyssynchrony is present in 70% of patients with a wide QRS complex and 30% with a narrow QRS complex, making this feature a weak marker of LV dyssynchrony

  • New echocardiographic techniques, such as tissue Doppler imaging, provide quick and accurate quantification of LV dyssynchrony

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Figure 1: Tracing derived from color-coded tissue Doppler imaging, four-chamber view, in a normal individual.
Figure 2: Tracings derived from color-coded tissue Doppler images, four-chamber views.
Figure 3: Segmental volume signals illustrating global left ventricular volume and left ventricular pressure from the apex to the base.

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Author information

Author notes

  1. GB Bleeker is a Research Fellow, JJ Bax, MJ Schalij and EE van der Wall are Professors of Cardiology and P Steendijk is an Associate Professor

Authors and Affiliations

  1. the Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

    Gabe B Bleeker, Jeroen J Bax, Paul Steendijk, Martin J Schalij & Ernst E van der Wall

Authors
  1. Gabe B Bleeker
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  2. Jeroen J Bax
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  3. Paul Steendijk
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  4. Martin J Schalij
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  5. Ernst E van der Wall
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Corresponding author

Correspondence to Ernst E van der Wall.

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The authors declare no competing financial interests.

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Bleeker, G., Bax, J., Steendijk, P. et al. Left ventricular dyssynchrony in patients with heart failure: pathophysiology, diagnosis and treatment. Nat Rev Cardiol 3, 213–219 (2006). https://doi.org/10.1038/ncpcardio0505

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