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1 Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
2 Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
3 Department of Cardiac Surgery, San Raffaele Hospital, Milan, Italy
4 Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
* To whom correspondence should be addressed. E-mail: p.steendijk{at}lumc.nl.
Mechanical dyssynchrony is an important co-determinant of cardiac dysfunction in heart failure. Treatment, either medical, surgical, or by pacing, may improve cardiac function to a large extent by improving mechanical synchrony. Consequently the quantification of ventricular mechanical (dys)synchrony may have important diagnostic and prognostic value and may help to determine optimal therapy. Therefore we introduced new indices to quantify temporal and spatial aspects of mechanical dyssynchrony derived from on-line segmental conductance catheter signals obtained during diagnostic cardiac catheterization. To test the feasibility and usefulness of our approach we determined cardiac function and left ventricular mechanical dyssynchrony by the conductance catheter in heart failure patients with intraventricular conduction delay (n=12) and in patients with coronary artery disease (n=6) and relatively preserved left ventricular function. The heart failure patients showed depressed systolic and diastolic function. However, the most marked hemodynamic differences between the groups were found for mechanical dyssynchrony indicating a high sensitivity and specificity of the new indices. Comparison of conductance catheter derived indices with septal-to-lateral dyssynchrony derived by tissue-Doppler velocity imaging showed highly significant correlations. The proposed indices provide additional, new and quantitative information on temporal and spatial aspects of mechanical dyssynchrony. They may refine diagnosis of cardiac dysfunction and evaluation of interventions, and ultimately help to select optimal therapy.
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