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01.12.2009 | Research | Ausgabe 1/2009 Open Access

Cardiovascular Ultrasound 1/2009

Prevalence and inter-relationship of different Doppler measures of dyssynchrony in patients with heart failure and prolonged QRS: a report from CARE-HF

Cardiovascular Ultrasound > Ausgabe 1/2009
Magnus Edner, Yong Kim, Knud Norregaard Hansen, Henrik Nissen, Geert Espersen, Karl La Rosee, Fikru Maru, Nick Freemantle, John Cleland, Peter Sogaard
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1476-7120-7-1) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

ME: Made substantial contributions to conception and design, acquisition, analysis and interpretation of data, mainly responsible for drafting the manuscript. YK: acquisition, analysis and interpretation of data and drafting the manuscript. KNK: acquisition, analysis and interpretation of data. GE: acquisition, analysis and interpretation of data. KLR: acquisition, analysis and interpretation of data. FM: acquisition, analysis and interpretation of data. NF: statistical analysis and interpretation of data. JGFC: analysis and interpretation of data, drafting the manuscript. PS: acquisition, analysis and interpretation of data, drafting the manuscript. All authors approved the final version.



Cardiac resynchronisation therapy (CRT) improves mortality and morbidity in heart failure patients with wide QRS. Observational studies suggest that patients having more left ventricular dyssynchrony pre-implantation obtain greater benefit on ventricular function and symptoms with CRT.


To provide an analysis of the prevalence and type of dyssynchrony in patients included in the CARE-HF trial.


100 patients 67 (58 to 71) years were examined with echocardiography including tissue doppler imaging before receiving a CRT-pacemaker. Atrio-ventricular dyssynchrony (LVFT/RR) was defined as left ventricular filling time <40% of the RR-interval. Inter-ventricular mechanical delay (IVMD) was measured as the difference in onset of Doppler-flow in the pulmonary and aortic outflow tracts >40 ms. Intra-ventricular (regional) dyssynchrony in a 16-segment model was expressed either as a delayed longitudinal contraction (DLC) during the postsystolic phase or by tissue synchronisation imaging (TSI) with a predefined time-difference in systolic maximal velocities >85 ms.


LVFT/RR was present in 34% and IVMD in 60% of patients while intra-ventricular dyssynchrony was present in 85% (DLC) and 86% (TSI) with a high agreement between the measures (Kappascore 0.86–1.00), indicating the methods being interchangeable. Patients with cardiomyopathy (53%) were more likely to have LVFT/RR <40% (45% vs. 21% (p= 0.02)) and more segments affected by intra-ventricular dyssynchrony 4(3, 5) vs. 3(1, 4), p = 0.002, compared to patients with ischemic heart disease.


The prevalence of intra-ventricular dyssynchrony is high in patients with heart failure, wide QRS and depressed systolic function. Most important, TSI appears to be a fast and reliable method to identify patients with intra-ventricular dyssynchrony likely to benefit from CRT.
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