Evaluation of Longitudinal and Radial Two-dimensional Strain Imaging Versus Doppler Tissue Echocardiography in Predicting Long-term Response to Cardiac Resynchronization Therapy

Knebel, Fabian; Schattke, Sebastian; Bondke, Hansjürgen; Walde, Torsten; Eddicks, Stephan; Reibis, Rona; Baumann, Gert; Borges, Adrian C.

doi:10.1016/j.echo.2006.09.007

Cited by 42 publications

(44 citation statements)

References 23 publications

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“…The usefulness of strain imaging in evaluating the CRT population has been reported in several studies, 18 -20,40,41 but others were not able to demonstrate the usefulness of the strain-derived dyssynchrony index. 42,43 In addition, in our study, almost 100% of patients with systolic dysfunction showed dyssynchrony if we use the proposed strain-derived cutoff value in the Mele et al 20 study. The reason for this discrepant result is not clear, but we speculate that a cutoff value that can predict the effect of CRT among heart failure population is higher than the one that can separate a normal from an abnormal population.…”

Section: Tissue Velocity Versus Strain For the Quantification Of Mechmentioning

confidence: 61%

Comparison of Echocardiographic Dyssynchrony Assessment by Tissue Velocity and Strain Imaging in Subjects With or Without Systolic Dysfunction and With or Without Left Bundle-Branch Block

et al. 2008

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Background-Several echocardiographic dyssynchrony indexes have been proposed to identify responders to cardiac resynchronization therapy using tissue velocity and strain. The present study aimed to compare tissue velocity-derived and strain-derived dyssynchrony indexes in patients with or without systolic dysfunction and left bundle-branch block. Methods and Results-Tissue Doppler imaging was performed in 120 subjects divided into 4 groups: group 1 (nϭ40), normal subjects; group 2 (nϭ20), normal left ventricular ejection fraction and left bundle-branch block; group 3 (nϭ20), left ventricular ejection fraction Ͻ35% and normal conduction; and group 4 (nϭ40), left ventricular ejection fraction Ͻ35% and left bundle-branch block. Dyssynchrony indexes based on time to peak tissue velocity (septal-lateral delay, anteroseptal-posterior delay, and SD in time to peak systolic velocity in the 12 left ventricular segments) and strain (SD of time to peak strain in 12 segments) were measured. The SD in time to peak systolic velocity in the 12 left ventricular segments was greater in group 4 (54 ms; 25th and 75th percentiles, 46 to 64 ms) than group 1 (44 ms; 25th and 75th percentiles, 28 to 53 ms; Pϭ0.006), but there was a considerable overlap of all tissue velocity-derived indexes among 4 groups, with 40% to 68% of group 1 having values proposed for predicting the responders of cardiac resynchronization therapy. The SD of time to peak strain in 12 segments distinguished these groups with much less overlap (PϽ0.01 for all pairwise comparisons). Conclusions-A substantial proportion of normal subjects have tissue velocity-derived dyssynchrony indexes higher than the cutoff value proposed for predicting beneficial effect of cardiac resynchronization therapy. Strain-derived timing index appears to be more specific for dyssynchrony in patients with systolic dysfunction and left bundle-branch block.Identifying an optimal tissue velocity-or strain-derived dyssynchrony index requires a large prospective clinical trial.

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Section: Tissue Velocity Versus Strain For the Quantification Of Mechmentioning

confidence: 61%

Comparison of Echocardiographic Dyssynchrony Assessment by Tissue Velocity and Strain Imaging in Subjects With or Without Systolic Dysfunction and With or Without Left Bundle-Branch Block

et al. 2008

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“…Although we did not have a measure of regional wall stress or strain in our study, previous studies have demonstrated CRT results in a more synchronous LV strain patterns in responders compared with nonresponders. 45,46 Further study is needed to explore the regional strain pattern in the accompanying regions where we measured LV ARI to elucidate whether mechanical stretch or strain may be the trigger for our observed changes in APD. It has been shown that increased dispersion of repolarization measured from body surface ECG leads varied between responders and nonresponders.…”

Section: Limitationsmentioning

confidence: 99%

Left Ventricular Epicardial Electrograms Show Divergent Changes in Action Potential Duration in Responders and Nonresponders to Cardiac Resynchronization Therapy

Chen

Hanson

Sohal

et al. 2013

Circ: Arrhythmia and Electrophysiology

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Background— A consistent feature of electrophysiological remodeling in heart failure is ventricular action potential duration (APD) prolongation. However, the effect of reverse remodeling on APD during cardiac resynchronization therapy (CRT) has not been determined in these patients. We hypothesized (1) that CRT may alter APD and (2) that the effect of CRT on APD may be different in patients who exhibit a good hemodynamic response to CRT compared with those with a poor response. Methods and Results— Left ventricular (LV) activation recovery intervals, as a surrogate for APD, were measured from the LV epicardium in 13 patients at day 0, 6 weeks, and 6 months after CRT implant. Responders to CRT were defined as those demonstrating a ≥15% reduction in LV end-systolic volume at 6 months. The responder group had a significant reduction in LV activation recovery interval (mean, −13±12 ms; median, −16 ms; interquartile range, −2 to −19 ms) during right ventricular pacing at 6 months ( P <0.05). Conversely, the nonresponders showed a significant increase in activation recovery interval (mean, +22 ms±16; median, 17 ms; interquartile range, 8 to 35 ms; P <0.05). One patient in each group was on amiodarone. Conclusions— In patients with heart failure, LV epicardial APD (activation recovery interval) altered during CRT. The effect on APD was opposite in patients showing a good hemodynamic response compared with nonresponders. The findings may provide an explanation for the persistent high incidence of arrhythmias in some patients with CRT and the additional mortality benefit observed in responders of CRT.

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“…Three studies concluded that the dyssynchrony index derived by strain did not predict CRT effect and that tissue velocity-derived dyssynchrony indexes were superior to strain-derived dyssynchrony for prediction of reverse remodeling. 17,36,37 The technical aspects of imaging may partly contribute to these discordant results. We imaged each cardiac wall individually, with the narrowest possible sector size, to minimize the Doppler angle and to increase lateral resolution with the highest obtainable frame rate.…”

Section: Prediction Of the Effect Of Crt By Assessment Of Strain-derimentioning

confidence: 99%

Strain Dyssynchrony Index Correlates With Improvement in Left Ventricular Volume After Cardiac Resynchronization Therapy Better Than Tissue Velocity Dyssynchrony Indexes

Miyazaki

Lin

Powell

et al. 2008

Circ: Cardiovascular Imaging

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Background-Various dyssynchrony indexes derived from tissue velocity and strain imaging have been proposed to predict the effectiveness of cardiac resynchronization therapy (CRT). We sought to compare the effect of CRT on dyssynchrony indexes derived by tissue velocity and strain and to determine which baseline intraventricular dyssynchrony parameters correlate with improvement in left ventricular volume after CRT. Methods and Results-Echocardiography with tissue Doppler imaging was performed in 45 patients with systolic heart failure at baseline, 1 day after CRT, and a median of 6 months after CRT. We calculated septal-lateral delay and anteroseptal-posterior delay and standard deviation of time to peak systolic velocity in the 12 basal and mid-left ventricular segments (Tv-SD). The standard deviation for time to peak strain in the 12 basal and mid-left ventricular segments (T-SD) was calculated as a strain-derived dyssynchrony index. None of the tissue velocity-derived dyssynchrony indexes improved after CRT (septal-lateral delay, Pϭ0.39; anteroseptal-posterior delay, Pϭ0.46; Tv-SD, Pϭ0.30), whereas T-SD decreased significantly after CRT (PϽ0.001). Improvement in T-SD 1 day after CRT correlated with the reduction in end-systolic volume at follow-up (rϭ0.66; PϽ0.001). Baseline T-SD demonstrated significant correlation with the reduction of end-systolic volume at follow-up (rϭ0.57; PϽ0.001); however, baseline tissue velocity-derived dyssynchrony indexes failed to predict the effect of CRT. Conclusions-The strain-derived dyssynchrony index is a better measurement than the tissue velocity dyssynchrony index for monitoring changes in mechanical dyssynchrony after CRT and for predicting reduction in left ventricular volume after CRT. (Circ Cardiovasc Imaging. 2008;1:14-22.)

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Evaluation of Longitudinal and Radial Two-dimensional Strain Imaging Versus Doppler Tissue Echocardiography in Predicting Long-term Response to Cardiac Resynchronization Therapy

Cited by 42 publications

References 23 publications

Comparison of Echocardiographic Dyssynchrony Assessment by Tissue Velocity and Strain Imaging in Subjects With or Without Systolic Dysfunction and With or Without Left Bundle-Branch Block

Comparison of Echocardiographic Dyssynchrony Assessment by Tissue Velocity and Strain Imaging in Subjects With or Without Systolic Dysfunction and With or Without Left Bundle-Branch Block

Left Ventricular Epicardial Electrograms Show Divergent Changes in Action Potential Duration in Responders and Nonresponders to Cardiac Resynchronization Therapy

Strain Dyssynchrony Index Correlates With Improvement in Left Ventricular Volume After Cardiac Resynchronization Therapy Better Than Tissue Velocity Dyssynchrony Indexes

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