Cardiac Dyssynchrony Quantitated by Time-to-Peak or Temporal Uniformity of Strain at Longitudinal, Circumferential, and Radial Level: Implications for Resynchronization Therapy

Bertola, Benedetta; Rondano, Elisa; Sulis, Marina; Sarasso, G; Piccinino, Cristina; Marti, Giuliano; Devecchi, Paolo; Magnani, Andrea; Francalacci, Gabriella; Marino, Paolo

doi:10.1016/j.echo.2009.03.010

Cited by 27 publications

(29 citation statements)

References 28 publications

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“…However, despite its overall efficacy, 30-40% of patients receiving CRT do not appear to benefit from this therapy [6] and one concern is that patient selection, which has been primarily based on widening of surface QRS, inadequately identifies chamber dyssynchrony (DYS) [7]. We recently showed that baseline DYS indexed by circumferentially assessed temporal uniformity of strain (TUS) yields greater CRT benefits than other asynchrony measurements [8]. However, it has been suggested that the success of CRT is not only dependent on the capability of the technique to cure dyssynchrony but also on technical factors such as optimized LV lead placement [9,10].…”

Section: Introductionmentioning

confidence: 98%

Baseline asynchrony, assessed circumferentially using temporal uniformity of strain, besides coincidence between site of latest mechanical activation and presumed left ventricular lead position, predicts favourable prognosis after resynchronization therapy

Cavallino

Rondano

Magnani

et al. 2011

Int J Cardiovasc Imaging

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Traditional indexes of LV dyssynchrony (DYS) in pts to be resynchronized are sensitive to noise, while the concordance between LV lead position and site of latest mechanical activation is suggested to be, in these patients, clinically relevant. Both aspects, asynchrony and lead position have been addressed separately but unclear is their potential synergistic role in the clinical evolution of CRT patients. We assessed clinical and echocardiographic outcome, as well as mid-term prognosis, in a population of CHF patients submitted to CRT, stratified according to a novel asynchrony quantitation (temporal uniformity of strain: TUS) method and concordance or not between presumed LV lead position and site of latest mechanical activation. TUS was computed in 85 pts (QRS > 120 ms, EF < 0.35) in whom we measured circumferential and longitudinal strains using speckle-tracking 2D-echocardiography before and 3-6 months after CRT, together with triplane apical LV volumes. Optimal LV lead position in short axis view was defined as concordance of the segment with latest systolic circumferential strain prior-CRT and segment with assumed LV lead position. Assumed LV lead position was defined from a chest X-ray obtained 1 day after implantation and scored as anterior, lateral, posterior or inferior using 2 orthogonal views (antero-posterior and lateral). Following CRT, LV volume decreased (diastolic -8 ± 20%) and EF improved (+6 ± 9%, P < 0.001 for both). Two-way ANOVA revealed TUS improvement post-CRT (+22 ± 68%, P = 0.025), with a clear evidence for more marked asynchrony detectable at circumferential (from 0.53 ± 0.20 to 0.55 ± 0.19) as compared with longitudinal level (from 0.56 ± 0.14 to 0.62 ± 0.14) (P = 0.017). Multivariate analysis revealed that greater baseline asynchrony, as assessed circumferentially (P = 0.079), together with concordance between LV lead position and site of activation (P = 0.012), besides younger age (P = 0.051), longer QRS duration (P = 0.021) and higher baseline EF (P = 0.04),), but not longitudinal TUS (P = 0.231) did predict death from any cause or new episodes of pulmonary or systemic congestion requiring i.v. diuretics during a 529 ± 357 days clinical follow-up. We conclude that DYS indexed by circumferential TUS yields CRT benefits, supporting the idea of targeting TUS-measured DYS as the informative asynchrony quantitative measurement in CRT pts. Significant predictability in medium-term clinical follow-up of patients to be resynchronized is also associated with concordance between site of latest mechanical activation and presumed LV lead position in the present study.

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Section: Introductionmentioning

confidence: 98%

Baseline asynchrony, assessed circumferentially using temporal uniformity of strain, besides coincidence between site of latest mechanical activation and presumed left ventricular lead position, predicts favourable prognosis after resynchronization therapy

Cavallino

Rondano

Magnani

et al. 2011

Int J Cardiovasc Imaging

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“…The LVESV reduction together with the classification between large/moderate responder/non-responder is given in Table 3. Improvements in both the magnitude and the synchronicity of myocardial strain among the different LV segments are expected for CRT responders (Delgado et al (2008); Bertola et al (2009)). This is illustrated for one responder (Patient # 1) in Fig.…”

Section: Data Acquisition and Databasementioning

confidence: 99%

“…CRT aims to restore synchrony of motion and strain in the four chambers. When looking specifically at the LV, CRT responders are expected to show at follow-up a higher peak strain value at the end of systole ) and an improved synchronization of the strain curves in the different LV segments (Delgado et al (2008); Bertola et al (2009)). Our algorithm was applied to a database of 13 CRT patients including both responders and non-responders before and after CRT, and at 6-and 12-months follow-ups, representing a total of 51 image sequences.…”

mentioning

confidence: 99%

Temporal diffeomorphic free-form deformation: Application to motion and strain estimation from 3D echocardiography

Craene

Piella

Cámara

et al. 2012

Medical Image Analysis

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This paper presents a new registration algorithm, called Temporal Diffeomorphic Free Form Deformation (TDFFD), and its application to motion and strain quantification from a sequence of 3D ultrasound (US) images. The originality of our approach resides in enforcing time consistency by representing the 4D velocity field as the sum of continuous spatiotemporal B-Spline kernels. The spatiotemporal displacement field is then recovered through forward Eulerian integration of the non-stationary velocity field. The strain tensor is computed locally using the spatial derivatives of the reconstructed displacement field. The energy functional considered in this paper weighs two terms: the image similarity and a regularization term. The image similarity metric is the sum of squared differences between the intensities of each frame and a reference one. Any frame in the sequence can be chosen as reference. The regularization term is based on the incompressibility of myocardial tissue. TDFFD was compared to pairwise 3D FFD and 3D+t FFD, both on displacement and velocity fields, on a set of synthetic 3D US images with different noise levels. TDFFD showed increased robustness to noise compared to these two state-of-the-art algorithms. TDFFD also proved to be more resistant to a reduced temporal resolution when decimating this synthetic sequence. Finally, this synthetic dataset was used to determine optimal settings of the TDFFD algorithm. Subsequently, TDFFD was applied to a database of cardiac 3D US images of the left ventricle acquired from 9 healthy volunteers and 13 patients treated by Cardiac Resynchronization Therapy (CRT). On healthy cases, uniform strain patterns were observed over all myocardial segments, as physiologically expected. On all CRT patients, the improvement in synchrony of regional longitudinal strain correlated with CRT clinical outcome as quantified by the reduction of end-systolic left ventricular volume at follow-up (6 and 12 months), showing the potential of the proposed algorithm for the assessment of CRT.

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“…Although methods based on time to peak strain are sensitive to noise and the influence of outliers, an alternative approach is measurement of temporal uniformity of strain, whereby a time plot of regional strains, arranged for LV location is subjected to Fourier analysis. 26 Dyssynchrony index by circumferential temporal uniformity of strain was more reproducible and yielded greater AUC for response than time to peak strain methods. 26 The cross-correlation delay method in which all data points from the velocity curves are incorporated, rather than a manual selection of peak velocities, appears to be a better discriminator of dyssynchrony between control subjects and CRT responders, although its ability to predict CRT response is only marginally better than the conventional TDI-based methods.…”

Section: Future Directionsmentioning

confidence: 99%

“…26 Dyssynchrony index by circumferential temporal uniformity of strain was more reproducible and yielded greater AUC for response than time to peak strain methods. 26 The cross-correlation delay method in which all data points from the velocity curves are incorporated, rather than a manual selection of peak velocities, appears to be a better discriminator of dyssynchrony between control subjects and CRT responders, although its ability to predict CRT response is only marginally better than the conventional TDI-based methods. 27 …”

Section: Future Directionsmentioning

confidence: 99%

Echocardiographic Assessment of Dyssynchrony

Chung

Mazur

2010

Circ: Heart Failure

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Cardiac Dyssynchrony Quantitated by Time-to-Peak or Temporal Uniformity of Strain at Longitudinal, Circumferential, and Radial Level: Implications for Resynchronization Therapy

Cited by 27 publications

References 28 publications

Baseline asynchrony, assessed circumferentially using temporal uniformity of strain, besides coincidence between site of latest mechanical activation and presumed left ventricular lead position, predicts favourable prognosis after resynchronization therapy

Baseline asynchrony, assessed circumferentially using temporal uniformity of strain, besides coincidence between site of latest mechanical activation and presumed left ventricular lead position, predicts favourable prognosis after resynchronization therapy

Temporal diffeomorphic free-form deformation: Application to motion and strain estimation from 3D echocardiography

Echocardiographic Assessment of Dyssynchrony

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