Echocardiographic evaluation of cardiac dyssynchrony: Does it still matter?

Mele, Donato; Luisi, Giovanni Andrea; Malagù, Michele; Laterza, A; Ferrari, Roberto; Bertini, Matteo

doi:10.1111/echo.13902

Cited by 16 publications

(10 citation statements)

References 53 publications

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“…As a consequence, mechanical dyssynchrony for patient selection has not been incorporated into guidelines or standard of care. 4,5 However, the three, simple, pulsed-Doppler parameters tested in the Predictors of Response to CRT study were interpretable in most examinations, showed good reproducibility, and had a statistically significant-although modest-performance in predicting outcomes. These parameters were left pre-ejection interval (LPEI), interventricular mechanical delay (IVMD), and LV filling time (LVFT)/RR interval.…”

Section: Introductionmentioning

confidence: 99%

Acute correction of electromechanical dyssynchrony and response to cardiac resynchronization therapy

2020

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Aims Echocardiographic measures of dyssynchrony at baseline have not demonstrated a good ability to predict response to cardiac resynchronization therapy (CRT). The purpose of this study was to determine if the acute correction of electromechanical dyssynchrony, assessed by the change in simple pulsed-Doppler measures, was related to CRT response at 6 months. Methods and results Echocardiography was performed at baseline and at pre-discharge after CRT implantation. Intraventricular, interventricular, and atrioventricular dyssynchrony were evaluated by the left pre-ejection interval (LPEI), the interventricular mechanical delay, and the ratio of left ventricular filling time to RR interval, respectivelxy. A patient was considered responder if he/she was alive without hospitalization for heart failure and had an absolute increase of left ventricular ejection fraction (LVEF) >5 points. Forty-eight patients (mean age 67 ± 11 years, 73% male, mean LVEF 30 ± 5%) were included. CRT led to an acute correction of intraventricular and interventricular dyssynchrony but not to an acute correction of atrioventricular dyssynchrony. There were 31 (65%) responders at 6 months. Two factors were independently associated with CRT response in multivariate analysis: ischemic cardiomyopathy (odds ratio 0.19, 95% confidence interval 0.04-0.87; P= 0.032) and delta LPEI (odds ratio 1.03 per 1 ms decrease, 95% confidence interval 1.01-1.05; P = 0.007). By receiver operating characteristic analysis, the optimal cut-off value of delta LPEI was À16 ms. The proportion of responders in patients without ischemic cardiomyopathy and with a delta LPEI greater than À16 ms was 85%. Conclusions Acute correction of intraventricular electromechanical dyssynchrony evaluated by the LPEI predicted CRT response at 6 months.

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Section: Introductionmentioning

confidence: 99%

Acute correction of electromechanical dyssynchrony and response to cardiac resynchronization therapy

2020

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“…We found a smaller difference in global T2P systolic LS between septal and lateral wall in survivors compared to controls (22.3 versus 27.9 ms, p-value 0.019) which seems clinically irrelevant. Cut off values for LVD in predicting successful resynchronization therapy have been recently described by Mele et al [21]. However, no cut-off values for LVD in predicting LV dysfunction in CCS have been identified.…”

Section: Discussionmentioning

confidence: 99%

Left ventricular dyssynchrony in long-term childhood cancer survivors treated with anthracyclines: a retrospective cross-sectional study

Pourier

Dull

Weijers

et al. 2021

Int J Cardiovasc Imaging

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The purpose of this study was to investigate left ventricular contraction patterns in asymptomatic Childhood cancer survivors (CCS) using two-dimensional speckle tracking echocardiography (2DSTE). Left ventricular longitudinal and circumferential myocardial parameters were assessed using 2DSTE, in asymptomatic CCS and age matched healthy controls. Time to peak (T2P) systolic strain was quantified. Dyssynchrony index (DI) was measured by calculating the standard deviation of T2P systolic strain of six segments in each view. Difference between T2P systolic longitudinal strain of septal and lateral wall was also assessed as a parameter for dyssynchrony. We included 115 CCS with a median age of 17.2 years (range 5.6–39.5) and a median follow up of 11.3 years (range 4.9–29.5) and 119 controls. Conventional echocardiographic parameters and global longitudinal strain were significantly decreased in CCS compared to controls (p < 0.01 and p = 0.02, respectively). Dyssynchrony index did not differ between CCS and controls. There was a clinically insignificant smaller absolute difference between T2P systolic longitudinal of septal and lateral wall in CCS compared to controls. We showed no difference in longitudinal or circumferential left ventricular dyssynchrony in CCS compared to controls using 2DSTE. Future research should focus on assessing dyssynchrony in more segments and a larger CCS population, using both 2D and 3DSTE.

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“…LV mechanical discoordination is a time-independent feature which improves the prediction of CRT response rather than mechanical dyssynchrony [ 47 , 48 ]. By using 2D STE in patients with LBBB, it is possible to identify the typical pattern of mechanical discoordination, characterized by early, rapid contraction of the septum and simultaneous passive stretching of the lateral wall, which begins and finishes its contraction later [ 39 , 49 ]. This classic pattern is predictive of response to CRT [ 50 ].…”

Section: New Ultrasound Technologies For Cardiac Resynchronization Therapymentioning

confidence: 99%

Left Ventricular Deformation and Vortex Analysis in Heart Failure: From Ultrasound Technique to Current Clinical Application

et al. 2021

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Heart failure (HF) is a leading cause of cardiovascular morbidity and mortality. However, its symptoms and signs are not specific or can be absent. In this context, transthoracic echocardiography plays a key role in diagnosing the various forms of HF, guiding therapeutic decision making and monitoring response to therapy. Over the last few decades, new ultrasound modalities have been introduced in the field of echocardiography, aiming at better understanding the morpho-functional abnormalities occurring in cardiovascular diseases. However, they are still struggling to enter daily and routine use. In our review article, we turn the spotlight on some of the newest ultrasound technologies; in particular, analysis of myocardial deformation by speckle tracking echocardiography, and intracardiac flow dynamics by color Doppler flow mapping, highlighting their promising applications to HF diagnosis and management. We also focus on the importance of these imaging modalities in the selection of responses to cardiac resynchronization therapy.

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Echocardiographic evaluation of cardiac dyssynchrony: Does it still matter?

Cited by 16 publications

References 53 publications

Acute correction of electromechanical dyssynchrony and response to cardiac resynchronization therapy

Acute correction of electromechanical dyssynchrony and response to cardiac resynchronization therapy

Left ventricular dyssynchrony in long-term childhood cancer survivors treated with anthracyclines: a retrospective cross-sectional study

Left Ventricular Deformation and Vortex Analysis in Heart Failure: From Ultrasound Technique to Current Clinical Application

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