الفهرس 
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Abstract
Mechanical dyssynchrony is a common phenomenon in patients with congestive heart failure, which usually identified by noninvasive cardiac imaging tools such as echocardiography. It demonstrates electromechanical delay in some regions of the failing heart which in turn contributes to further impairment of cardiac function. The diagnostic, therapeutic and prognostic values of mechanical dyssynchrony have been reported in a number of studies.
The aim of this study was to assess the prevalence and pattern of intra left ventricular dyssynchrony in heart failure patients with normal QRS complex and with left bundle branch block.
This study was conducted at cardiology department at Benha University Hospital, 90 individual were enrolled in the study and they were divided into 3 groups, group (1) heart failure with normal QRS complex, group (2) heart failure patients with LBBB and group (3) normal individual, while patients with , RBBB, permanent pacemaker, atrial fibrillation, primary valvular disease, previous valve replacement and Those who had suffered from major cardiovascular events in the previous 6 weeks were excluded from the study.
The patients were observed for ECG, conventional echocardiography and tissue synchronization imaging (TSI) parameters.
In the current study, mean age of group (1) was 54.23±9.231 years, group (2) was 51.63±10.496years and group (3) was 43.43±3.181 years with statistically significance difference between all groups and p value < 0.001.
Regarding sex there was no significance difference between the three groups with P value >0.05.
There was statistically significant difference between the three groups in disease history including; Hypertension, diabetes mellitus, current smoking, history of CAD p value <0.001, while history of smoking was significant with p value <0.05.
Mean QRS duration, was significant different between group1 and group 2 with p value <0.001.
Regarding LVESV, LVEDV and LVEF between the study groups, there was no significance difference between group 1 (HF with normal QRS) and group 2 (HF with LBBB) with P value >0.05, while there was significance difference between group 1 and group 3 (normal) with P value <0.001 and also there was significance difference between group 2 and group 3 with P value <0.001.
Regarding TSI parameters, there was significance difference between study groups in septal lateral delay, all segments maximum delay and all segments stander deviation with p value <0.001.
Also, regarding other parameters of TSI there was significance difference between the 12 segments of left ventricle in all study groups, with P value (<0.001).
Concerning LV dyssynchrony in group (1), Twenty patients (66.7%) had significant dyssynchrony parameters with all segment stander deviation >33, while 10 (33.3%) patients had no evidence of mechanical dyssynchrony with all segments stander deviation <33.
The latest activated segment in group (1) was LV inferior wall (10 patients, 33.3%) followed by posterior wall (6 patients, 20%), anterior (5 patients, 16.7%), antero-septal (5 patients, 16.7%), septal (3 patients, 10%) and lateral (1 patient, 3.3%).
While, LV dyssynchrony in group (2); twenty five patients (83.3%) had mechanical dyssynchrony with all segments stander deviation >33 while 5 patients (16.7) did not have mechanical dyssynchrony with all segments stander deviation < 33.
The latest activated segment in group (2) was LV lateral wall (7 patients, 33.3%), followed by posterior (6 patients, 20%), inferior (6 patients, 20%), anterior (6 patients, 20%), antero-septal (4 patients, 13.3%) and septal wall (1 patient, 3.3%).
Regarding LV dyssynchrony in group (3), there was no mechanical dyssynchrony (0 patients, 0%), the latest activated segment in this group was LV lateral wall (12 patients, 40%), followed by antero-septal (11 patients, 36.7%), septal wall (3 patients, 10%), posterior wall (2 patients, 6.7%), anterior wall (1 patient, 3.3%) and inferior wall (1 patient, 3.3%).