It is unknown whether physiological ageing also goes along with electromechanical asynchrony of contraction. Aim of the study was to evaluate synchrony of contraction in older people with ("non-healthy") or without ("healthy") evidence for structural cardiac disease. In 547 persons (age 76.7+/-5.5 years, 306 male, 241 female) recruited from a population-based cohort of the ActiFE-Ulm study including a random sample of people >/=65 years old living in the region of Ulm, Germany, various PW- and TDI-Doppler based markers for asynchrony were obtained by echocardiography. Within a subgroup of 84 healthy subjects, at most minimal systolic and diastolic asynchrony was found. Concerning systolic asynchrony, similar observations were made within the non-healthy subgroup. However, extent of diastolic left ventricular intraventricular asynchrony and also - by tendency - diastolic interventricular asynchrony was increased in comparison to the healthy subgroup. To conclude, no evidence that physiological ageing might go along with relevant left or right ventricular systolic or diastolic electromechanical asynchrony was found in our study. Furthermore, our population-based data support the results from other clinical studies with rather selected cohorts that structural heart diseases might go along with increased diastolic asynchrony.

• MeSH
• Diastole MeSH
• Echocardiography, Doppler MeSH
• Ventricular Dysfunction, Left diagnostic imaging   epidemiology   physiopathology   MeSH
• Ventricular Dysfunction, Right diagnostic imaging   epidemiology   physiopathology   MeSH
• Ventricular Function, Left * MeSH
• Ventricular Function, Right * MeSH
• Humans MeSH
• Cross-Sectional Studies MeSH
• Risk Factors MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Excitation Contraction Coupling MeSH
• Aging MeSH
• Systole MeSH
• Age Factors MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH
• Geographicals
• Germany epidemiology   MeSH

Cíl práce: Řada experimentálních i klinických studií prokazuje, že stimulace hrotu pravé komory (PK) srdeční vede k výrazné asynchronii aktivace komor. Výsledkem může být porucha systolické i diastolické funkce levé komory (LK) srdeční. Řešením je stimulace z alternativních míst PK. Cílem předložené studie je srovnání vlivu stimulace septa vs. hrotu na echokardiograficky hodnocené parametry komorové dyssynchronie ve střednědobém sledování. Metodika: Do studie bylo zařazeno 41 pacientů (31 mužů, průměrný věk 73 ± 10 let) s pokročilou AV blokádou a zachovanou ejekční frakcí LK (EF > 45 %). Pacienti byli randomizováni v poměru 2 : 1 k septální nebo hrotové stimulaci. Elektroda s aktivní fixací byla umístěna buď na septum nebo do hrotu PK. Echokardiografické vyšetření včetně hodnocení tkáňového dopplerovského vyšetření (TDE) bylo provedeno do týdne po implantaci a v odstupu šesti měsíců. Hodnotili jsme parametry interventrikulární a intraventrikulární dyssynchronie. Interventrikulární mechanické zpoždění (IVMD) bylo hodnoceno jako rozdíl mezi preejekčním časem levé a pravé komory. Intraventrikulární dyssynchronie LK byla analyzována z výsledků TDE – hodnotili jsme rozdíl rychlosti vrcholu kontrakce septa a laterální stěny LK. Výsledky: Bezprostředně po implantaci byl preejekční čas levé komory srdeční ve skupině septální stimulace 141 ± 22 ms, ve skupině hrotové stimulace 148 ± 23 ms, za 6 měsíců pak 142 ± 30 ms, resp. 151 ± 24 ms. IVMD činilo 20 ± 23 ms u stimulace septa, 21 ± 19 ms u stimulace hrotu, za 6 měsíců pak 36 ± 16 ms, resp. 35 ± 21 ms. Rozdíl vrcholu kontrakce septa a laterální stěny činil 28 ± 58 ms a 24 ± 55 ms při vstupním vyšetření a 39 ± 56 ms, resp. 37 ± 56 ms po šesti měsících. Závěr: V předložené studii jsme u nemocných se zachovanou funkcí LK neprokázali statisticky významný rozdíl mezi vlivem stimulace septa vs. hrotu PK na parametry interventrikulární a intraventrikulární dyssynchronie ani akutně, ani ve střednědobém sledování. V obou skupinách jsme však zaznamenali velký individuální rozptyl ve všech sledovaných parametrech.

Aim of study: A number of experimental and clinical studies have shown that right ventricular (RV) apical pacing leads to marked asynchrony of ventricular activation. This can result in systolic and diastolic left ventricular (LV) dysfunction. A solution is pacing from alternative RV sites. The study was designed to compare the effect of septal vs. apical pacing using echocardiographic parameters of ventricular dyssynchrony on mid-term follow-up. Method: Forty-one patients (31 men, mean age 73 ± 10 years) with advanced AV block and preserved LV ejection fraction (EF > 45%) were included into the study. Patients were randomized to septal or apical pacing at a 2 : 1 ratio. The electrode with active fixation was placed either on the septum or the RV apex. Echocardiography including tissue Doppler echocardiography (TDE) was performed within a week post-implant and at a six-month interval. We assessed parameters of interventricular and intraventricular dyssynchrony. Interventricular mechanical delay (IVMD) was assessed as the difference between pre-ejection left and right ventricular times. Intraventricular LV dyssynchrony was analyzed using TDE data, assessed as the difference in peak velocities of septal and LV lateral wall contraction.

• MeSH
• Ventricular Dysfunction, Left MeSH
• Echocardiography MeSH
• Financing, Organized MeSH
• Ventricular Function, Right MeSH
• Electrodes, Implanted MeSH
• Cardiac Pacing, Artificial methods   MeSH
• Ventricular Dysfunction MeSH
• Humans MeSH
• Check Tag
• Humans MeSH

The present study proposed procedure for predicting an optimal left and right ventricular pacing interval delay (V-V interval). In 16 patients (heart failure, left bundle branch block, biventricular pacing) two methods (A and B) identifying optimal V-V interval were tested. Method A: predicted optimal V-V interval A (POVVA) = electromechanical delay of the segment paced by left ventricle lead minus electromechanical delay of the segment paced by right ventricle lead. Method B: predicted optimal V-V interval B (POVV-B) = difference in the onset of aortic and pulmonary flows. Both methods were validated using echocardiography and right-sided heart catheterization. Cardiac output during POVV-A (4.6 l.min-1) was significantly better than that during POVV-A minus 20 ms (4.3 l.min-1, p<0.01) and POVVA plus 20 ms (4.3 l.min-1, p<0.01), and than that during POVV-B (4.4 l.min-1, p<0.05). LV dP/dt during POVV-A (818 mm Hg.s-1) exceeded that during POVV-A plus 20 ms (717 mm Hg.s-1, p<0.05) and POVV-A minus 20 ms (681 mm Hg.s-1, p<0.05), and that during POVV-B (727 mm Hg.s-1, p<0.01). The time difference in onsets of myocardial deformation of left ventricle segment paced by the left ventricle and right ventricle lead allows identifying the optimal V-V interval and improves left ventricle performance.

• Keywords
• Biventricular pacing, Inter-ventricular asynchrony, Intraventricular asynchrony, V-V interval, Cardiac resynchronization therapy,
• MeSH
• Action Potentials MeSH
• Time Factors MeSH
• Adult MeSH
• Financing, Organized MeSH
• Ventricular Function, Left MeSH
• Cardiac Pacing, Artificial methods   MeSH
• Ventricular Pressure MeSH
• Middle Aged MeSH
• Humans MeSH
• Cardiac Output MeSH
• Heart Conduction System physiopathology   MeSH
• Echocardiography, Doppler, Pulsed MeSH
• Reproducibility of Results MeSH
• Aged MeSH
• Cardiac Catheterization MeSH
• Heart Failure physiopathology   therapy   ultrasonography   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH