Left Ventricular Dyssynchrony by Three‐Dimensional Echocardiography: Current Understanding and Potential Future Clinical Applications

Abstract

Left ventricular mechanical dyssynchrony is an important prognostic factor for patients with symptomatic systolic heart failure and has emerged as a therapeutic target for cardiac resynchronization therapy (CRT). However, approximately one-third of patients fail to improve after CRT based on current guideline recommendations and electrocardiographic criteria. Two-dimensional echocardiography and tissue Doppler-based techniques have shown variable results in assessment of left ventricular (LV) dyssynchrony and have limited value in clinical practice. Three-dimensional echocardiography (3DE) is an appealing novel imaging modality that has been recently used in quantitative evaluation of global and regional LV function. There is accumulating evidence that 3DE measurement of LV systolic dyssynchrony index may potentially play a role in predicting the short- and long-term response to CRT and further improve patient selection for CRT. New developments in 3DE speckle tracking technique and strain analysis may further improve the accuracy of LV mechanical dyssynchrony assessment in this population. In addition, recent studies suggest that mechanical dyssynchrony is present in patients with LV hypertrophy and diastolic heart failure. Three-dimensional echocardiographic assessment of dyssynchrony may aid in diagnosis and in predicting long-term outcome in these patients. We will summarize current understanding of 3DE techniques and parameters in assessment of LV mechanical dyssynchrony in the population of patients with systolic heart failure, LV hypertrophy, and diastolic heart failure. A number of the novel 3DE techniques described in this review are early in their stage of development, and they will continue to evolve and need further testing in large multicenter studies.

Predictive value of global and territorial longitudinal strain imaging in detecting significant coronary artery disease in patients with myocardial infarction without persistent ST‐segment elevation

“…Recently, two‐dimensional (2D) speckle‐tracking echocardiographic (STE) imaging is being performed frequently for assessment of cardiovascular diseases . Global longitudinal strain (GLS) and strain rate analyses using 2D STE are superior to conventional echocardiographic imaging for left ventricular function assessment .…”

Left ventricular dyssynchrony in coronary artery disease patients without regional wall‐motion abnormality: Correlation with Gensini score

“…It has been demonstrated that LV contraction occurs in a highly coordinated manner. Left ventricular systolic performance is affected not only by the contractile status of the myocardium, but also by the synchronicity of the myocardial segments . In fact, myocardial systolic dyssynchrony includes both differences in myocardial segment systolic amplitude and systolic peak time.…”

“…The 3DQ software displays the time‐volume tracings for each LV segment (pyramidal subvolume), and the time to minimum systolic volume is automatically identified for LV segments 16, 12, and 6. The 16R‐SDI, 12R‐SDI, 6R‐SDI parameters were calculated from the SD of LV segment (16, 12, 6) timings and are expressed as the percentage of the cardiac cycle as previously described …”

“…QRS duration, two‐dimensional speckle tracking echocardiography (2D‐STE), and tissue Doppler imaging (TDI) have been widely used to determine LVD, but with different results due to their inherent limitations . Single‐beat real time 3DE (RT‐3DE) is a novel noninvasive imaging technique that can acquire full‐volume images while avoiding the stitch artifact, and it offers more accurate and detailed quantitative information regarding mechanical dyssynchrony . Although extensive studies have used three‐dimensional echocardiography (3‐DE) to assess the value of LVD in predicting the response to CRT and detecting diastolic heart failure, the role of 3‐DE‐derived LVD parameters in non‐RWMA CAD patients has not been well studied.…”

Strain Imaging Echocardiography: What Imaging Cardiologists Should Know

“…Three-dimensional STE imaging has emerged as a useful modality when compared to either 2-D-STE or TDI for the ongoing evaluation of LV dyssynchrony [43]; however, prediction of both responses to CRT and LV reverse remodeling requires more studies with prospective data [44, 45]. …”