Mechanical dyssynchrony: How do we measure it, what it means, and what we can do about it

Left ventricular mechanical dyssynchrony (LVMD) is defined by a difference in the timing of mechanical contraction or relaxation between different segments of the left ventricle (LV). Mechanical dyssynchrony is distinct from electrical dyssynchrony as measured by QRS duration and has been of increas...

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Bibliographic Details
Published in:Journal of nuclear cardiology 2021-10, Vol.28 (5), p.2174-2184
Main Authors: Fudim, Marat, Dalgaard, Frederik, Fathallah, Mouhammad, Iskandrian, Ami E., Borges-Neto, Salvator
Format: Article
Language:English
Subjects:
Aged
Arrhythmias, Cardiac - classification
Arrhythmias, Cardiac - therapy
Cardiology
Cardiomyopathy
Cardiovascular disease
dyssynchrony
Electrocardiography
Electrocardiography - methods
Female
Humans
Imaging
Male
Mechanical Phenomena
Medical imaging
Medicine
Medicine & Public Health
Middle Aged
Nuclear Medicine
Prognosis
Radiology
Review Article
SPECT
Weights and Measures - instrumentation
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Summary:Left ventricular mechanical dyssynchrony (LVMD) is defined by a difference in the timing of mechanical contraction or relaxation between different segments of the left ventricle (LV). Mechanical dyssynchrony is distinct from electrical dyssynchrony as measured by QRS duration and has been of increasing interest due to its association with worse prognosis and potential role in patient selection for cardiac resynchronization therapy (CRT). Although echocardiography is the most used modality to assess LVMD, some limitations apply to this modality. Compared to echo-based modalities, nuclear imaging by gated single-photon emission computed tomography (GSPECT) myocardial perfusion imaging (MPI) has clear advantages in evaluating systolic and diastolic LVMD. GSPECT MPI can determine systolic and diastolic mechanical dyssynchrony by the variability in the timing in which different LV segments contract or relax, which has prognostic impact in patients with coronary artery disease and heart failure. As such, by targeting mechanical dyssynchrony instead of electrical dyssynchrony, GSPECT MPI can potentially improve patient selection for CRT. So far, few studies have investigated the role of diastolic dyssynchrony, but recent evidence seems to suggest high prevalence and more prognostic impact than previously recognized. In the present review, we provide an oversight of mechanical dyssynchrony.
ISSN:1071-3581
1532-6551
DOI:10.1007/s12350-019-01758-0