Noninvasive Assessment of Cardiac Resynchronization Therapy for Congestive Heart Failure Using Myocardial Strain and Left Ventricular Peak Power as Parameters of Myocardial Synchrony and Function

Popović, Zoran B.; Grimm, Richard A.; Perlic, George; Chinchoy, Edward; Geraci, M A; Sun, Jing Ping; Donal, Erwan; Xu, Xiao Fang; Greenberg, Neil L.; Wilkoff, Bruce L.; Thomas, James D.

doi:10.1046/j.1540-8167.2002.01203.x

Cited by 56 publications

(39 citation statements)

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“…9 Very recently, the assessment of strain has also been suggested to be useful to assess mechanical events in the ventricle. 24 The present study is the largest prospective study that used TDI, PSS, and SRI to assess cardiac intraventricular and interventricular asynchrony for patients receiving CRT and in a balanced number of patients with ischemic and nonischemic causes. The results demonstrated that TDI parameters closely predict LV reverse remodeling and that Ts-SD (the "asynchrony index") is the single best predictor.…”

Section: Tdi Pss Sri and Reverse Remodelingmentioning

confidence: 99%

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Tissue Doppler Imaging Is Superior to Strain Rate Imaging and Postsystolic Shortening on the Prediction of Reverse Remodeling in Both Ischemic and Nonischemic Heart Failure After Cardiac Resynchronization Therapy

et al. 2004

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Background-A number of noninvasive techniques have been used to predict the effectiveness of cardiac resynchronization therapy (CRT) in heart failure patients, in particular left ventricular (LV) reverse remodeling. This study compared the relative predictive values of tissue Doppler imaging (TDI) and strain-rate imaging (SRI) parameters for LV reverse remodeling in patients who received CRT and examined for potential differences in ischemic (nϭ22) and nonischemic (nϭ32) heart failure. Methods and Results-TDI and SRI were performed at baseline and 3-month follow-up. Eighteen parameters of intraventricular and interventricular asynchrony based on the time to peak myocardial contraction (Ts) and time to peak strain rate (Tsr) were compared, along with postsystolic shortening (PSS). Reverse remodeling with reduction of LV end-diastolic and end-systolic volumes and gain in ejection fraction (all PϽ0.001) was observed in the whole study population. The standard deviation of Ts of 12 LV segments (Ts-SD) is the most powerful predictor of reverse remodeling in both the ischemic (rϭϪ0.65, PϽ0.001) and nonischemic (rϭϪ0.79, PϽ0.001) groups. The PSS of 12 LV segments was a good predictor only for the nonischemic (rϭϪ0.64, PϽ0.001) but not the ischemic (rϭ0.32, PϭNS) group. However, parameters of SRI and interventricular asynchrony failed to predict reverse remodeling. By multiple regression analysis, independent parameters included Ts-SD in both groups (PϽ0.005) and PSS of 12 LV segments in the nonischemic group (Pϭ0.03). The area of the receiver operating characteristic curve was largest for Ts-SD (0.94; CIϭ0.88 to 1.00). Conclusions-Ts-SD is the most powerful predictor of LV reverse remodeling and was consistently useful for ischemic and nonischemic heart failure. However, PSS is useful only for nonischemic pathogenesis, whereas the role of SRI parameters was not supported by the present study.

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Section: Tdi Pss Sri and Reverse Remodelingmentioning

confidence: 99%

“…However, such benefit may be offset by the relatively large interobserver and intraobserver variability (at least Ͼ16%). 24 …”

Section: Tdi Pss Sri and Reverse Remodelingmentioning

confidence: 99%

Tissue Doppler Imaging Is Superior to Strain Rate Imaging and Postsystolic Shortening on the Prediction of Reverse Remodeling in Both Ischemic and Nonischemic Heart Failure After Cardiac Resynchronization Therapy

et al. 2004

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“…14 The peak strain in each segment was determined as the difference in strain measured from the onset of the QRS complex to the nadir of the strain tracing. 15 We also calculated the coefficient of variation for the time at which the maximum strain was recorded in each region (CV-time).…”

Section: Tissue Doppler Imaging (Tdi) and Strain Doppler Imaging (Sdi)mentioning

confidence: 99%

“…1,4 In this regard, TDI has emerged as a technique that allows accurate assessment of the regional timing of mechanical events relative to the phase of the cardiac cycle. [4][5][6][7][8][9][10][11][12]14 Recent studies have reported the usefulness of TDI for assessing and quantifying LV dyssynchrony. Specifically, the intraventricular conduction delay in the LV can be measured by placing 2 sample volumes at the base of the septum and lateral wall, and a delay ≥60 ms between the peak systolic velocity of the septum and the lateral wall before BVP can predict clinical improvement after BVP.…”

Section: Role Of Tdi and Sdi In Patients Undergoing Bvpmentioning

confidence: 99%

“…[5][6][7][8][9][10][11][12][13] Furthermore, recent advances in TDI and strain Doppler imaging (SDI) have enhanced the ability to evaluate ventricular synchrony and regional myocardial function. [5][6][7][8][9][10][11][12][13][14][15][16] However, the utility and efficacy of TDI and SDI for evaluating ventricular synchrony and function and for predicting long-term clinical improvement in patients undergoing BVP have not been sufficiently determined. The purpose of this study was to clarify this point.…”

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Tissue Doppler Imaging and Strain Doppler Imaging as Modalities for Predicting Clinical Improvement in Patients Receiving Biventricular Pacing

Tada

Toide

Naito

et al. 2005

Circ J

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iventricular pacing (BVP) is currently indicated for the treatment of patients with medically refractory heart failure and electrical dyssynchrony, 1-4 but it is becoming increasingly clear that QRS duration is an inadequate predictor of the response to BVP therapy. [4][5][6] Because the improvement in mechanical dyssynchrony after BVP correlates with improvement in clinical status and reverse remodeling, [6][7][8][9][10][11][12] there are ongoing investigations to determine the most accurate and efficient method of detecting mechanical dyssynchrony. Echocardiography, including tissue Doppler imaging (TDI), is simple, easy and ideal for evaluating regional wall motion. [5][6][7][8][9][10][11][12][13] Furthermore, recent advances in TDI and strain Doppler imaging (SDI) have enhanced the ability to evaluate ventricular synchrony and regional myocardial function. [5][6][7][8][9][10][11][12][13][14][15][16] However, the utility and efficacy of TDI and SDI for evaluating ventricular synchrony and function and for predicting long-term clinical improvement in patients undergoing BVP have not been sufficiently determined. The purpose of this study was to clarify this point. Methods Study PopulationThis study included 17 patients with advanced heart failure and a wide QRS complex who received a pacemaker or an implantable cardioverter defibrillator (ICD) providing BVP. There were 12 men and 5 women, and their mean age was 66±9 years; 13 patients had idiopathic cardiomyopathy, 2 had ischemic heart disease, and the remaining 2 had valvular heart disease; 11 patients were in New York Heart Association (NYHA) functional class IV, and the remaining 6 were in class III despite maximal pharmacologic therapy at the time of pacemaker implantation. The QRS interval was >140 ms and the left ventricular (LV) ejection fraction determined by echocardiography was <40% in all the patients.Patients were divided into 2 groups according to their clinical status at the end of the follow-up period (23±7 months; range: 14-37 months): the responder group (n=12) and the nonresponder group (n=5; Table 1). The clinical status of each patient was determined at the end of the follow-up period by 2 cardiologists who did not have any information concerning the BVP status of the patients. A responder was defined as a patient who improved clinically to NYHA functional class I or II during the follow-up period and a nonresponder was one who did not. There was no significant difference between the 2 groups in the NYHA classification before the initiation of BVP (p=0.9; Background The purpose of this study was to determine the utility and efficacy of tissue Doppler imaging (TDI) and strain Doppler imaging (SDI) for evaluating ventricular synchrony and function, and for predicting the long-term clinical improvement in patients undergoing biventricular pacing (BVP). Methods and Results TDI and SDI were performed before and <1 month after initiating BVP in 17 patients with advanced heart failure. An intraventricular conduction delay between the left ventricu...

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What Echocardiography May Offer Cardiac Resynchronization Therapy

Abraham¹

2004

Resynchronization and Defibrillation for Heart Failure

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Noninvasive Assessment of Cardiac Resynchronization Therapy for Congestive Heart Failure Using Myocardial Strain and Left Ventricular Peak Power as Parameters of Myocardial Synchrony and Function

Abstract: Using novel noninvasive indices, we demonstrated that cardiac resynchronization therapy improves LV performance.

Cited by 56 publications

References 8 publications

Tissue Doppler Imaging Is Superior to Strain Rate Imaging and Postsystolic Shortening on the Prediction of Reverse Remodeling in Both Ischemic and Nonischemic Heart Failure After Cardiac Resynchronization Therapy

Tissue Doppler Imaging Is Superior to Strain Rate Imaging and Postsystolic Shortening on the Prediction of Reverse Remodeling in Both Ischemic and Nonischemic Heart Failure After Cardiac Resynchronization Therapy

Tissue Doppler Imaging and Strain Doppler Imaging as Modalities for Predicting Clinical Improvement in Patients Receiving Biventricular Pacing

What Echocardiography May Offer Cardiac Resynchronization Therapy

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