Viswanathan, T (2014) Echocardiographic assessment of inter and intra ventricular dyssynchrony in heart failure patients with normal QRS duration. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION : The management of patients with heart failure is an important issue in cardiology. The cost of healthcare associated with management and hospitalization is substantial. Device therapy for patients refractory to medical therapy focuses on improving the clinical outcome and quality of life. Normally Electrical activation and conduction through the His Purkinje network occurs fast. This results in synchronous mechanical contraction of the heart. Many diseases of the heart produce changes in the temporal sequence of early and late systolic contraction of different regions of the myocardium1. This results in abnormal contraction pattern due to the resultant electromechanical dyssynchrony. This causes an increase in the duration of QRS on ECG. Some studies report mechanical dyssynchrony in a subgroup of patients with diastolic heart failure2 too. Dyssynchrony has also been reported in some patients with heart failure and decreased ejection fraction and a normal QRS duration3. The differential regional activation and dyssynchronous left ventricular contraction by decreasing ejection and relaxation has the net effect of reduced cardiac output. Work efficiency of the myocardium is also decreased because of the dyssynchrony. Heart failure is associated with alterations in the local and systemic neuro hormonal milieu playing an important role in pathological remodeling and changes at the cellular level1,4. Superimposition of electrical conduction delay and mechanical dyssynchrony over this setting results in additive effects and creates complex pathological changes and increased propensity to arrhythmias. AIMS & OBJECTIVES : To assess the prevalence of inter and intraventricular dyssynchrony in patients with heart failure and Normal QRS duration echocardiographically using M mode and Tissue Doppler imaging (TDI). CONCLUSION ; 1. Intra and interventricular dyssynchrony occur in a significant proportion of heart failure patients with a QRS duration of 120 ms or less. The prevalence of intra ventricular electromechanical dyssynchrony was 23% and interventricular dyssynchrony 16 % 2. Among the indices of intraventricular dyssynchrony, The dyssynchrony index(Ts-SD) and peak velocity difference (Ts diff ) show good inter parameter correlation compared to septal posterior wall motion delay SPWMD. 3. There is no association between the QRS duration and the dyssynchrony parameters in the study. 4. There is no association between interventricular dyssynchrony and intraventricular dyssynchrony.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Echocardiographic ; inter and intra ventricular dyssynchrony ; heart failure patients ; normal QRS duration. |
| Subjects: | MEDICAL > Cardiology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 06 Jul 2017 00:54 |
| Last Modified: | 06 Jul 2017 09:58 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1056 |
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