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Archives of cardiovascular diseases
Volume 110, n° 1
pages 60-68 (janvier 2017)
Doi : 10.1016/j.acvd.2016.12.002
Received : 22 September 2016 ;  accepted : 1 December 2016
Mechanical dyssynchrony in heart failure: Still a valid concept for optimizing treatment?
Asynchronisme mécanique et insuffisance cardiaque : un concept valide pour optimiser la thérapie ?

Figure 1

Figure 1 : 

Example of septal flash identified on two-dimensional grey-scale images. A. The presence of an abnormal contraction and relaxation of the septum within the isovolumic contraction period results in a short inward motion of the septum (arrows). B. The delayed activation of the lateral wall then pulls the apex laterally during the ejection time, while stretching the septum; this typical apex motion pattern is described as “apical rocking”.

Figure 2

Figure 2 : 

Systolic strain traces from the septum and lateral wall in a patient with left bundle branch block. During left bundle branch block without cardiac resynchronization therapy, there is a marked septal shortening during pre-ejection, accompanied by pre-ejection lengthening in the lateral wall (green arrows). AV: aortic valve.

Figure 3

Figure 3 : 

Example of left ventricular pressure-strain loops in a patient with left bundle branch block in the lateral (LAT) wall and septal (SEPT) segments. In the lateral segment, the area of the loop reflects segmental work. In the septal segment, loop area is markedly reduced relative to the lateral segment, which implies that septal work is markedly reduced. Bullseyes represent cardiac work and wasted work ratio in a patient with left bundle branch block, which depicts the significant imbalance in cardiac work and work efficiency between the septum and the lateral wall. ANT: anterior; INF: inferior; POST: posterior.

Figure 4

Figure 4 : 

Example of the strain curves obtained in a patient with very severely depressed left ventricular systolic function. Some dispersion of the strain peaks exists, but part of this is related to a passive expansion of the myocardium, and some strain peaks are weaker than |5|%, which corresponds to too weak a systolic deformation to be related to a viable myocardium. ANT: anterior; AVC: aortic valve closure; INF: inferior; LAT: lateral; POST: posterior; SEPT: septal.

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