Pilot study using 3D–longitudinal strain computation in a multi-parametric approach for best selecting responders to cardiac resynchronization therapy

Abstract

BackgroundAlmost all attempts to improve patient selection for cardiac resynchronization therapy (CRT) using echo-derived indices have failed so far. We sought to assess: the performance of homemade software for the automatic quantification of integral 3D regional longitudinal strain curves exploring left ventricular (LV) mechanics and the potential value of this tool to predict CRT response.MethodsForty-eight heart failure patients in sinus rhythm, referred for CRT-implantation (mean age: 65 years; LV-ejection fraction: 26%; QRS-duration: 160 milliseconds) were prospectively explored. Thirty-four patients (71%) had positive responses, defined as an LV end-systolic volume decrease ≥15% at 6-months. 3D–longitudinal strain curves were exported for analysis using custom-made algorithms. The integrals of the longitudinal strain signals (IL,peak) were automatically measured and calculated for all 17 LV-segments.ResultsThe standard deviation of longitudinal strain peak (SDIL,peak) for all 17 LV-segments was greater in CRT responders than non-responders (1.18% s−1 [0.96; 1.35] versus 0.83% s−1 [0.55; 0.99], p = 0.007). The optimal cut-off value of SDIL,peak to predict response was 1.037%.s−1. In the 18-patients without septal flash, SDIL,peak was significantly higher in the CRT-responders.ConclusionsThis new automatic software for analyzing 3D longitudinal strain curves is avoiding previous limitations of imaging techniques for assessing dyssynchrony and then its value will have to be tested in a large group of patients.

The CHA₂DS₂-VASc Score and Its Association with Long-Term Outcome in a Cardiac Resynchronization Therapy Population

“…Some scores, detailed above but not tested in this study, include more advanced echocardiographic data (than for instance LVEF). These are methods of great interest but still have not shown a reproducible ability to identify responders of CRT [21]. No scores to date include perioperative data such as interelectrode electrical delay or left ventricular lead positioning, in combination with preoperative variables.…”

Advances in Cardiac Resynchronization Therapy

“…Similarly, Fournet et al in their pilot study discussed the potential role of analyzing three-dimensional strain curves using automated quantification by way of computerized algorithms to predict CRT response. 29 Tao et al separately shared their observations upon using gated single-photon-emission computed tomography myocardial perfusion imaging to assess both scar burden and contractility pattern, with a U-shaped contractility pattern significantly associated with LVEF improvement versus a non-U-shaped contractility pattern. 30 Similarly, cardiac magnetic resonance imaging has also been effective in assessing scar burden, which is associated with a reduced response to CRT, as well as global ventricular dyssynchrony pattern.…”

Regional Left Ventricular Fiber Stress Analysis for Cardiac Resynchronization Therapy Response

“… 9 Assessment of regional mechanical function to predict CRT response seems promising. 18 , 31 , 35 , 38 Studies have shown that dyssynchronous ventricles disperse myocardial work and that modification of myocardial workload is a key factor in the reverse remodeling seen after CRT. 13 , 14 , 36 One study suggests that the so-called “wasted work”-parameter during the isovolumetric phase of the heart cycle may be a predictor.…”