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Abstract: Background: Cardiac resynchronization therapy (CRT) is an important therapeutic approach for patients with symptomatic heart failure. The assessment of mechanical dyssynchrony, however, remains an issue. Little data are available regarding the influence of the right ventricle (RV) on left ventricle (LV) mechanical dyssynchrony as assessed by echocardiography. Aims: We sought to assess the impact of RV contractility on LV function and dyssynchrony. Methods: A total of 40 patients with congestive heart failure were analyzed. Twenty had RV dysfunction, as defined by a tricuspid annular systolic peak of tissue Doppler (SaRV) <11.5cm/s, while the remaining 20 had SaRV>11.5cm/s. All patients underwent echocardiography in order to determine RV function, LV function, and dyssynchrony. Results: The two populations were similar regarding diastolic function, atrio-ventricular conduction and interventricular dyssynchrony. Patients with RV dysfunction showed significantly more severe LV longitudinal dyssynchrony (130±103ms vs. 62±59ms; p =0.01). In addition, SaRV (systolic peak recorded at the tricuspid annulus) was correlated with LV longitudinal dyssynchrony (r =0.47; p =0.001). In contrast, LV radial contractility and dyssynchrony (103±110ms vs. 100±78ms; p =0.5) were not affected by RV function. Conclusion: Quantitative analysis of RV function is important when assessing LV function and dyssynchrony in patients with systolic heart failure. RV function is associated with intra-LV dyssynchrony, particularly when considering longitudinal function. [Copyright &y& Elsevier]

Background: Cardiac resynchronization therapy (CRT) improves heart failure (HF) symptoms through a reduction of cardiac mechanical dyssynchrony. Mechanical dyssynchrony is currently estimated by electrical dyssynchrony (QRS duration). It is known that electrical and mechanical dyssynchrony are not well correlated in HF patients. However, there is limited information about whether this relationship might be influenced by the underlying cardiomyopathy. Methods: Doppler echocardiography was performed in 88 patients presenting with heart failure due to ischemic (n = 42) or nonischemic (n = 46) heart disease, left ventricular ejection fraction <40%, New York Heart Association class II–IV, regardless of their QRS duration. Interventricular dyssynchrony was assessed by the time interval between preaortic and prepulmonary ejection times. Intraventricular dyssynchrony was ascertained by (1) the delay between the earliest and the latest peak negative longitudinal strain recorded in the basal and mid-segments of the lateral and septal walls (TMinMax) and (2) the standard deviation of time-to-peak in the same segments (SDdys). Results: The correlation coefficient between QRS duration and mechanical interventricular dyssynchrony was r = 0.47 (P < 0.001) in patients with nonischemic disease and nonsignificant in patients with ischemic disease. Similarly, the correlation coefficient between QRS duration and mechanical intraventricular dyssynchrony was significant in patients with nonischemic disease (r = 0.37, P = 0.01 for TMinMax; r = 0.42, P = 0.003 for SDdys) and nonsignificant in patients with ischemic disease. Conclusion: The concordance between electrical dyssynchrony assessed by QRS duration and mechanical dyssynchrony assessed by myocardial strain is dependent upon the underlying cardiomyopathy. This observation may improve our understanding of the various responses observed in CRT patients. [ABSTRACT FROM AUTHOR]

Reports on a case of endocarditis due to Fusarium dimerum four years after coronary artery bypass grafting. Fusarium species most frequently involved in human pathology; Histological evidence of internal organ infection.