Rational Pharmacotherapy in Cardiology

Advanced search


Full Text:


Review of scientific evidences on contemporary concepts of the pathogenesis of mechanical dyssynchrony and its significance in patients with chronic heart failure is presented.

About the Authors

Yu. V. Stavtseva
Russian Peoples' Friendship University, Moscow
Russian Federation

S. V. Villevalde
Russian Peoples' Friendship University, Moscow
Russian Federation

A. V. Sveshnikov
National Center of Medicine and Surgery named after N.I. Pirogov, Moscow
Russian Federation

J. D. Kobalava
Russian Peoples' Friendship University, Moscow
Russian Federation


1. Kass DA, Chen CH, Curry C, et al. Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay. Circulation 1999;99: 1567-73.

2. Cleland JG, DaubertJC, Erdmann E, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005;352:1539-49.

3. Yu CM, Wing-Hong FJ, Zhang Q, Sanderson JE. Understanding nonresponders of cardiac resynchronization therapy—current and future perspectives. J Cardiovasc Electrophysiol 2005;16:1117-24.

4. Suffoletto MS, Dohi K, Cannesson M, Saba S, Gorcsan JIII. Novel speckle-tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy. Circulation 2006;113:960-8.

5. Bax JJ, Bleeker GB, Marwick TH, et al. Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. J Am Coll Cardiol 2004;44:1834-40.

6. Cho GY, Song JK, Park WJ, et al. Mechanical dyssynchrony assessed by tissue Doppler imaging is a powerful predictor of mortality in congestive heart failure with normal QRS duration.J Am Coll Cardiol 2005; 46: 2237-43.

7. Bax JJ, Ansalone G, Breithardt OA, et al. Echocardiographic evaluation of cardiac resynchronization therapy: ready for routine clinical use? A critical appraisal. J Am Coll Cardiol 2004;44:1-9.

8. Spach MS, Miller WT, Geselowitz DB et al. The discontinuous nature of propagation in normal canine cardiac muscle.Evidence for recurrent discontinuities of intracellular resistance that affect the membrane currents. Circ Res 1981; 48: 39-54.

9. Prinzen FW, Augustijn CH, Arts T et al. Redistribution of myocardial fiber strain and blood flow by asynchronous activation. Am J Physiol 1990; 259: H300-H308.

10. Myerburg RJ, Gelband H, Nilsson K et al. The role of canine superficial ventricular fi bers in endocardial impulse conduction. Circ Res 1978; 42: 27-35.

11. Li D, Fareh S, Leung TK et al. Promotion of atrial fibrillation by heart failure in dogs: atrial remodelling of a different sort. Circulation 1999; 100: 87-95.

12. Sanders P, Kistler PM, Morton JB et al. Remodeling of sinus node function in patients with congestive heart failure. Reduction of sinus node reserve. Circulation 2004; 110: 897-903.

13. Bernheim A, Ammann P, Sticherling C et al. Right atrial pacing impairs cardiac function during resynchronization therapy. J Am Coll Cardiol 2005; 45: 1482-87.

14. Olgin JE, Kalman JM, Fitzpatrick AP et al. Role of right atrial endocardial structures as barriers to conduction during human type I atrial fl utter: activation and entrainment mapping guided by intracardiac echocardiography. Circulation 1995; 92: 1839-48.

15. Sanders P, Morton JB, Davidson NC et al. Electrical remodeling of the atria in congestive heart failure. Electrophysiological and electroanatomic mapping in humans. Circulation 2003; 108: 1461-8.

16. Auricchio A, Fantoni C, Regoli F et al. Characterization of left ventricular activation in patients with heart failure and left bundle branch block. Circulation 2004; 109: 1133-9.

17. Verbeek X, Vernooy K, Peschar M et al. Quantification of interventricular asynchrony during left bundle branch block and ventricular pacing. Am J Physiol 2002; 283: H1370-H1378.

18. Wyndham CRC, Smith T,MeeranMKet al. Epicardial activation in patientswith left bundle branch block.Circulation 1980; 61: 696-703.

19. Vassallo JA, Cassidy DM, Marchlinski FE et al. Endocardial activation of left bundle branch block. Circulation 1984; 69: 914-23.

20. Fantoni C, Regoli F, Kawabata M, Klein HU, Auricchio A. Reversed transmural activation timing in patients with heart failure and left bundle branch block. Eur Heart J 2004 (suppl): 2320.

21. Hesse B, Diaz LA, Snader CE et al. Complete bundle branch block as an independent predictor of allcause mortality: report of 7,073 patients referred for nuclear exercise testing. Am J Med 2001; 110: 253-9.

22. Fantoni C, Kawabara M, Massaro R et al. Right and left ventricular activation sequence in patients with heartfailure and right bundle branch block.Adetailed analysis using 3Dnon-fluoroscopic electroanatomic mapping system. J Cardiovasc Electrophysiol 2005; 16: 112-9.

23. Vernooy K, Verbeek XAAM, Peschar M et al. Left bundle branch block induces ventricular remodeling and functional septal hypoperfusion. Eur Heart J 2005; 26: 91-8.

24. Leclercq C, Gras D, Le HellocoA et al. Hemodynamic importance of preserving the normal sequence of ventricular activation in permanent cardiac pacing. Am Heart J 1995; 129: 1133-41.

25. Little WC, Reeves RC, Arciniegas J, Katholi RE, Rogers EW. Mechanism of abnormal interventricular septal motion during delayed left ventricular activation. Circ Res 1982; 65: 1486-90.

26. Prinzen FW, van Oosterhout MFM, Vanagt WYR, Storm C, Reneman RS. Optimization of ventricular function by improving the activation sequence during ventricular pacing.PACE 1998; 21: 2256-60.

27. Gilmore JP, Sarnoff SJ, MitchellJH, Linden RJ. Synchronicity of ventricular contraction: observations comparing hæmodynamic effects of atrial and ventricular pacing. Br Heart J 1963; 25: 299-307.

28. Lee MA, Dae MW, Langberg JJ et al. Effects of long-term right ventricular apical pacing on left ventricular perfusion, innervation, function and histology. J Am Coll Cardiol 1994; 24: 225-32.

29. Prinzen FW, Hunter WC, Wyman BT, McVeigh ER. Mapping of regional myocardial strain and work during ventricular pacing: experimental study using magnetic resonance imaging tagging. J Am Coll Cardiol 1999;33:1735-42.

30. Owen CH, EspositoDJ,Davis JW, GlowerDD. The effects of ventricular pacing on left ventricular geometry, function, myocardial oxygen consumption, and efficiency of contraction in conscious dogs. Pacing Clin Electrophysiol 1998;21:1417-29

31. Baller D, Wolpers HG, Zipfel J, et al. Comparison of the effects of right atrial, right ventricular apex and atrioventricular sequential pacing on myocardial oxygen consumption and cardiac efficiency: a laboratory investigation. Pacing Clin Electrophysiol 1988;11:394-403.

32. Aoyagi T, Iizuka M, Takahashi T, et al. Wall motion asynchrony prolongs time constant of left ventricular relaxation. Am J Physiol 1989;257:H883-H890.

33. Yano M, Kohno M, Konishi M, et al. Influence of left ventricular regional nonuniformity on afterloaddependent relaxation in intact dogs. Am J Physiol 1994;267:H148-H154.

34. Wang J, Kurrelmeyer KM, Torre-Amione G, Nagueh SF. Systolic and diastolic dyssynchrony in patients with diastolic heart failure and the effect of medical therapy. J Am Coll Cardiol 2007;49:88-96.

35. Kass DA. An epidemic of dyssynchrony: but what does it mean? J Am Coll Cardiol 2008;51:12-7.

36. Helm PA, Younes L, Beg MF, et al. Evidence of structuralremodeling in the dyssynchronous failing heart. Circ Res 2006;98:125-32.

37. Thambo JB, Bordachar P, Garrigue S, et al. Detrimental ventricular remodeling in patients with congenital complete heart block and chronic right ventricular apical pacing. Circulation 2004;110:376672.

38. Bilchick KC, Saha SK, Mikolajczyk E, et al. Differential regional gene expression from cardiac dyssynchrony induced by chronic right ventricular free wall pacing in the mouse.Physiol Genomics. 2006;26:109-15.

39. Spragg DD, Leclercq C, Loghmani M, et al. Regional alterations in protein expression in the dyssynchronous failing heart. Circulation 2003;108:929-32.

40. Chakir K, Daya SK, Tunin RS, et al. Reversal of Global Apoptosis and Regional Stress Kinase Activation by Cardiac Resynchronization.Circulation. 2008;117:1369-77.

41. Trichon BH, Felker GM, Shaw LK, et al. Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure. Am J Cardiol 2003;91:538-43.

42. Koelling TM, Aaronson KD, Cody RJ, et al. Prognostic significance of mitral regurgitation and tricuspid regurgitation in patients with left ventricular systolic dysfunction. Am Heart J 2002;144: 524-9.

43. Vinereanu D. Mitral regurgitation and cardiac resynchronization therapy. Echocardiography 2008;25:1155-66.

44. Kanzaki H, Bazaz R, Schwartzman D, et al. A mechanism for immediate reduction in mitral regurgitation after cardiac resynchronization therapy: insights from mechanical activation strain mapping. J Am Coll Cardiol 2004;44:1619-25.

45. Soyama A, Kono T, Mishima T, et al. Intraventricular dyssynchrony may play a role in the development of mitral regurgitation in dilated cardiomyopathy. J Card Fail 2005;11:631-7.

46. Langer F, Tibayan FA, Rodriguez F, et al. Altered mitral valve kinematics with atrioventricular and ventricular pacing. J Heart Valve Dis 2005;14: 286-94. 47. Szymanski P, Klisiewicz A,Hoffman P. Asynchronous movement of mitral annulus: an additional mechanism of ischaemic mitral regurgitation. Clin Cardiol 2007;30:512-6.

47. Liang YJ, Zhang Q, Fang F, et al. Incremental value of global systolic dyssynchrony in determining the occurrence of functional mitral regurgitation in patients with left ventricular systolic dysfunction. Eur Heart J 2013;34(10):767-74.

48. Ypenburg C, Lancellotti P, Tops LF, et al. Mechanism of improvement in mitral regurgitation after cardiac resynchronization therapy. Eur Heart J 2008;29:757-65.

49. Breithardt OA, Sinha AM, Schwammenthal E, et al. Acute effects of cardiac resynchronization therapy on functional mitralregurgitation in advanced systolic heart failure.J Am Coll Cardiol 2003;41:76570.

50. St John Sutton MG, Plappert T, Abraham WT, et al; Multicenter InSync Randomized Clinical Evaluation (MIRACLE) Study Group. Effect of cardiac resynchronization therapy on left ventricular size and function in chronic heart failure. Circulation 2003;107:1985-90.

51. Angeja BG, Grossman W. Evaluation and management of diastolic heart failure. Circulation 2003;107:659-63.

52. Yu CM, Zhang Q, Yip GW, et al. Diastolic and systolic asynchrony in patients with diastolic heart failure: a common but ignored condition. J Am Coll Cardiol 2007;49:97-105.

53. Lee AP, Zhang Q, Yip G, et al. LV mechanical dyssynchrony in heart failure with preserved ejection fraction complicating acute coronary syndrome. JACC Cardiovasc Imaging 2011;4:348-57.

54. Lee AP, Song JK, Yip GW, et al. Importance of dynamic dyssynchrony in the occurrence of hypertensive heart failure with normal ejection fraction. Eur Heart J 2010;31:2642-9.

55. Bader H, Garrigue S, Lafitte S, et al. Intra-left ventricular electromechanical asynchrony. A new independent predictor of severe cardiac events in heart failure patients. J Am Coll Cardiol 2004;43:24856.

56. Cho GY, Kim HK, Kim YJ, et al. Electrical and mechanical dyssynchrony for prediction of cardiac events in patients with systolic heart failure. Heart 2010;96:1029-32.

57. Shin SH, Hung CL, Uno H, et al; Valsartan in Acute Myocardial Infarction Trial (VALIANT) Investigators. Mechanical dyssynchrony after myocardial infarction in patients with left ventricular dysfunction, heart failure, or both. Circulation 2010;121:1096-103.

58. Penicka M, Bartunek J, Lang O, et al. Severe left ventricular dyssynchrony is associated with poor prognosis in patients with moderate systolic heart failure undergoing coronary artery bypass grafting. J Am Coll Cardiol 2007;50:1315-23.

59. Chung ES, Leon AR, Tavazzi L, et al. Results of the Predictors of Response to CRT (PROSPECT) trial. Circulation 2008;117: 2608-16.

60. Yu CM, Sanderson JE, Gorcsan J 3rd. Echocardiography, dyssynchrony, and the response to cardiac resynchronization therapy. Eur Heart J 2010;31:2326-37.

61. Van Bommel RJ, Ypenburg C, Borleffs CJ, et al. Value of tissue Doppler echocardiography in predicting response to cardiac resynchronization therapy in patients with heart failure. Am J Cardiol 2010;105:1153-8.

62. Delgado V, van Bommel RJ, Bertini M, et al. Relative merits of left ventricular dyssynchrony, left ventricular lead position, and myocardial scar to predict long-term survival of ischemic heart failure patients undergoing cardiac resynchronization therapy. Circulation 2011;123:70-8.

63. ShenkmanHJ, Pampati V, Khandelwal AK, et al. Congestive heartfailure and QRS duration: establishing prognosis study. Chest 2002;122:528-34.

64. Yu CM, Lin H, Zhang Q, et al. High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration. Heart 2003;89:54-60.

65. Bleeker GB, Holman ER, Steendijk P, et al. Cardiac resynchronization therapy in patients with a narrow QRS complex. J Am Coll Cardiol 2006;48:2243-50.

66. Gasparini M, Regoli F, Galimberti P, et al. Three years of cardiac resynchronization therapy: could superior benefits be obtained in patients with heart failure and narrow QRS? Pacing Clin Electrophysiol 2007;30(Suppl 1):S34-9.

67. Leon AR, Niazi I, Herrmann K, et al. Chronic evaluation of CRT in narrow QRS patients with mechanical dyssynchrony from a multicenter study: ESTEEM-CRT. Paper presented at Heart Rhythm Society Congress; May 15, 2008; San Francisco, CA.

68. Beshai JF, Grimm RA, Nagueh SF, et al. Cardiac-resynchronization therapy in heart failure with narrow QRS complexes. N Engl J Med 2007;357:2461-71.

69. Ruschitzka F, Abraham WT, Singh JP, et al. Cardiac-resynchronization therapy in heart failure with a narrow QRS complex. N Engl J Med 2013; 369:1395.


For citations:

Stavtseva Yu.V., Villevalde S.V., Sveshnikov A.V., Kobalava J.D. KEY PATHOGENETIC ASPECTS AND CLINICAL RELEVANCE OF MECHANICAL DYSSYNCHRONY. Rational Pharmacotherapy in Cardiology. 2014;10(2):220-230. (In Russ.)

Views: 644

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)