Impact of Left Ventricular Size on Tissue Doppler and Longitudinal Strain by Speckle Tracking for Assessing Wall Motion and Mechanical Dyssynchrony in Candidates for Cardiac Resynchronization Therapy

2009 ◽  
Vol 22 (6) ◽  
pp. 695-701 ◽  
Author(s):  
Pascal Lim ◽  
Laurens Mitchell-Heggs ◽  
Adisai Buakhamsri ◽  
James D. Thomas ◽  
Richard A. Grimm
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Wall Motion ◽  
Tissue Doppler ◽  
Mechanical Dyssynchrony ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Ventricular Size ◽  
Resynchronization Therapy

Abstract 2816: Assessment Of Left Ventricular Mechanical Dyssynchrony With Radial Strain By Speckle-tracking Best Predicts Response To Cardiac Resynchronization Therapy

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Victoria Delgado ◽  
Claudia Ypenburg ◽  
Laurens F Tops ◽  
Sjoerd A Mollema ◽  
Nina Ajmone Marsan ◽  
...  
Keyword(s):  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Radial Strain ◽  
Mechanical Dyssynchrony ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Speckle Tracking Imaging ◽  
Resynchronization Therapy ◽  
Left Ventricular Mechanical Dyssynchrony

Background: Recently, 2-dimensional strain by speckle tracking imaging has emerged as a new technology for assessment of myocardial deformation in three dimensions: radial, circumferential and longitudinal. The current study evaluates which type of deformation study can best identify left ventricular mechanical dyssynchrony (LVMD) and predicts response to cardiac resynchronization therapy (CRT). Methods: One-hundred fifty-two consecutive patients underwent echocardiographic study before implantation of the CRT device and at 6 months follow-up. Radial (RS) and circumferential (CS) strains were applied to midventricular short axis views; difference in time to peak systolic strain value between anteroseptal-to-posterior walls was used to study LVMD. Longitudinal strain (LS) was applied to apical 4-chamber views and LVMD was calculated as the difference between basal septum-to-basal lateral walls. Patients with a decrease of LV end-systolic volume ≥15% at 6 months follow-up were considered responders. Results: After 6 months of CRT, 85 pts (56%) showed response to CRT. Compared to non-responders, responders had significant more LVMD when it was assessed by RS (212±146 ms vs. 127±108 ms; p<0.001), whereas there were no differences with neither CS nor LS (Table ). With RS, the optimal cut-off value to predict response to CRT was identified at a time-difference value of ≥130 ms yielding a sensitivity of 83% and a specificity of 71%. Conclusions: Radial strain by speckle-tracking imaging is a useful tool to assess LVMD and best predicts echocardiographic response to CRT. Left Ventricular Mechanical Dyssynchrony assessed by radial, circumferential and longitudinal strain

scholarly journals The use of mechanical dyssynchrony for predicting response to cardiac resynchronization therapy in patients with non-ischemic cardiomyopathy

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
V Saushkin ◽  
YV Varlamova ◽  
AI Mishkina ◽  
DI Lebedev ◽  
SV Popov ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Myocardial Perfusion ◽  
Cardiac Resynchronization Therapy ◽  
Ischemic Cardiomyopathy ◽  
Gated Spect ◽  
Mechanical Dyssynchrony ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Crt Response

Abstract Funding Acknowledgements Type of funding sources: None. Aim/Introduction: Assessment of mechanical dyssynchrony by myocardial perfusion gated-SPECT in patients with non-ischemic cardiomyopathy for predict response to cardiac resynchronization therapy (CRT). Materials and Methods  We examined 32 patients with non-ischemic cardiomyopathy before and six months after CRT.  Left ventricular mechanical dyssynchrony and contractility were assessed for all patients by myocardial perfusion gated-SPECT. The phase standard deviation (PSD), histogram bandwidth (HBW), phase histogram skewness (S) and phase histogram kurtosis (K) were used as an indicator of mechanical dyssynchrony for the both ventricles.  Results  Mechanical dyssynchrony of both ventricles before CRT was increased in all patients. Median value PSD 53°(41-61°), HBW 176°(136-202°), S 1,62(1,21-1,89), K 2,81(1,21-3,49). Six months after CRT 22(68%) respondents were identified. We divided the patients into two groups (responders and non-responders) and compared phase parameters. It was found that the PSD (44°(35-54°)) and HBW (158°(118-179°) in the responders were significantly lower than in the non-responders (PSD (68°(58-72°); HBW (205°(199-249°)). The value of phase histogram skewness and kurtosis in responders were significantly higher (Responders: S 1,77(1,62-2,02); K 3,03(2,60-3,58). Non-responders: S 1,21(0,93-1,31); K 1,21(0,19-1,46)).  We found that all four indicators of mechanical dyssynchrony can predict CRT response according to the results of univariate logistic regression analysis. Moreover, It was found that only phase histogram kurtosis (OR = 1.196, 95% CI 1.04-1.37) is an independent predictor of CRT response according to multivariate logistic regression. Conclusion  Radionuclide assessment of mechanical dyssynchrony may be the optimal diagnostic method for selecting patients with non-ischemic cardiomyopathy on CRT.

Abstract 2819: Identification and Characterization of Super-Responders to Cardiac Resynchronization Therapy: An Echocardiographic Study

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Amira Zaroui ◽  
Patricia Reant ◽  
Erwan Donal ◽  
Aude Mignot ◽  
Pierre Bordachar ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Lv Function ◽  
Resynchronization Therapy ◽  
Systolic Volume ◽  
End Systolic Volume

In some patients, cardiac resynchronization therapy (CRT) has been recently shown to induce a spectacular effect on left ventricular (LV) function and inverted remodeling with nearby normalization of LV contraction. Objectives: To analyze and characterize super-responders (CRTSR) by echocardiography before CRT. 186 patients have been investigated before and 6 months after implantation of a CRT device with conventional indication according to ESC guidelines. Echocardiographies including measurements of LV dimensions, and contraction by 2-dimensional strain, and pressure assessment, mitral valve analysis were performed at baseline and at 6 months in an independent core-center lab. CRTSR were defined as a reduction of end-systolic volume of at least 15% and an ejection fraction (EF)>50% and were compared to normal responder patients (CRTNo, patients with a reduction of end-systolic volume of at least 15% but an EF <50%). 17/186 patients (9.1%) were identified as CRTSR, only 2 with ischemic cardiomyopathy (p<0.01). No difference was observed regarding NYHA status, EKG duration or EF between CRTSR and CRTNo at baseline. CRTSR presented with significant lower end-diastolic and end-systolic diameters (64±9mm vs 73±9mm (p<0.01) and 53±7.4mm vs 63±8.4mm (p<0.01), respectively), and end-diastolic and end-systolic volumes 161±44ml vs 210±76ml (p<0.02) and 123±43ml vs 163±69ml (p<0.01)) as well as a higher LV dP/dt max (714±251mmHg.s −1 vs 527±188 mmHg.s −1 (p<0.05)). Regarding strain analysis, CRTSR had significantly higher longitudinal values than CRTNo (−12.8±3% vs −9±2.6%, p<0.001) whereas no difference was observed for other components (p ns). Global longitudinal strain obtained by ROC curves was identified as the best parameter for predicting CRTSR with a cut-off value of −11% (Se=80%, Spe=87%, AUC=0.89, p<0.002) and was confirmed as an independent predictor by the logistic regression (RR: 21.3, p<0.0001). In a large multicenter study, CRT super-responders (EF>50%) were observed in 9% of the population and were associated with less-depressed LV function as determined by strain analysis. Global longitudinal strain appears to be the best predictor of CRTSR.

Abstract 3286: Prediction for Long-term Effect Of Cardiac Resynchronization Therapy: Comparison Between Tissue Doppler Imaging And Speckle Tracking Imaging

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Azusa Furugen ◽  
Naoki Matsuda ◽  
Kyomi Ashihara ◽  
Asako Mochida ◽  
Morio Shoda ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Tissue Doppler Imaging ◽  
Speckle Tracking ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Cardiac Resynchronization ◽  
Speckle Tracking Imaging ◽  
Resynchronization Therapy ◽  
Time To Peak ◽  
Qrs Duration

Recent studies have demonstrated that the septal-to-posterior motion delay (SPWMD) assessed by M-mode echo and the longitudinal intra-LV dyssynchrony assessed by tissue Doppler imaging (TDI) can predict chronic effects of cardiac resynchronization therapy (CRT). A newly developed 2D speckle tracking imaging (STI) has enabled assessment of not only longitudinal but circumferential regional strain of LV. We investigated the usefulness of STI in selecting patients for CRT. Methods: Fifty-one patients with heart failure symptoms and QRS duration>120 ms underwent standard echocardiography, TDI and STI before CRT. Time to peak systolic velocity was measured in 12 basal and mid LV segments in apical views by TDI. The time difference between the basal septal and the basal lateral segments was calculated (TDI-SLPVD).The standard deviation of those among 12 segments was calculated (TDI-SD). Time to peak circumferential strain, radial strain and longitudinal strain were measured in basal segments in parasternal short axis and apical views by STI. The time difference between the septal and the lateral segments was calculated (CS-SL, RS-SL and LS-SL). A responder to CRT was defined as a patient whose NYHA class improved by >1 class and whose LVESV reduced by >10% at 6 months after CRT. Results: Thirty-six patients (71%) responded to CRT. CS-SL showed high sensitivity and specificity for predicting the responders at a cut-off point of 124 ms (Table ). The area under the ROC curve (AUC) of CS-SL was larger than that of QRS duration, SPWMD, TDI-SLPVD, TDI-SD, RS-SL and LS-SL. Conclusion: Assessment of circumferential dyssynchrony using STI seems useful in selecting patients for CRT.

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