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 < or = 120 ms (Group 1), 33 patients had a QRS duration between 120 and 150 ms (Group 2), and 34 patients had a QRS duration > or = 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.