scholarly journals Optimization of cardiac resynchronization therapy based on speckle tracking

2019 ◽  
Vol 120 (08) ◽  
pp. 552-557
Author(s):  
D. Sipula ◽  
M. Kozak ◽  
J. Sipula ◽  
M. Homza ◽  
J. Plasek ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Speckle Tracking ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy

scholarly journals Excitation and Contraction of the Failing Human Heart In Situ and Effects of Cardiac Resynchronization Therapy: Application of Electrocardiographic Imaging and Speckle Tracking Echo-Cardiography

Hearts ◽  
2021 ◽  
Vol 2 (3) ◽  
pp. 331-349
Author(s):  
Christopher M. Andrews ◽  
Gautam K. Singh ◽  
Yoram Rudy
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Cardiac Electrophysiology ◽  
Speckle Tracking ◽  
Contractile Function ◽  
Cardiac Resynchronization ◽  
Reverse Remodeling ◽  
Resynchronization Therapy ◽  
Electromechanical Delay ◽  
Electrocardiographic Imaging ◽  
Activation Sequence

Despite the success of cardiac resynchronization therapy (CRT) for treating heart failure (HF), the rate of nonresponders remains 30%. Improvements to CRT require understanding of reverse remodeling and the relationship between electrical and mechanical measures of synchrony. The objective was to utilize electrocardiographic imaging (ECGI, a method for noninvasive cardiac electrophysiology mapping) and speckle tracking echocardiography (STE) to study the physiology of HF and reverse remodeling induced by CRT. We imaged 30 patients (63% male, mean age 63.7 years) longitudinally using ECGI and STE. We quantified CRT-induced remodeling of electromechanical parameters and evaluated a novel index, the electromechanical delay (EMD, the delay from activation to peak contraction). We also measured dyssynchrony using ECGI and STE and compared their effectiveness for predicting response to CRT. EMD values were elevated in HF patients compared to controls. However, the EMD values were dependent on the activation sequence (CRT-paced vs. un-paced), indicating that the EMD is not intrinsic to the local tissue, but is influenced by factors such as opposing wall contractions. After 6 months of CRT, patients had increased contraction in native rhythm compared to baseline pre-CRT (baseline: −8.55%, 6 months: −10.14%, p = 0.008). They also had prolonged repolarization at the location of the LV pacing lead. The pre-CRT delay between mean lateral LV and RV electrical activation time was the best predictor of beneficial reduction in LV end systolic volume by CRT (Spearman’s Rho: −0.722, p < 0.001); it outperformed mechanical indices and 12-lead ECG criteria. HF patients have abnormal EMD. The EMD depends upon the activation sequence and is not predictive of response to CRT. ECGI-measured LV activation delay is an effective index for CRT patient selection. CRT causes persistent improvements in contractile function.

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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