Simple regional strain pattern analysis to predict response to cardiac resynchronization therapy: Rationale, initial results, and advantages

Risum, Niels; Jøns, Christian; Olsen, Niels Thue; Fritz‐Hansen, Thomas; Bruun, Niels Eske; Vinther, Michael; Valeur, Nana; Kronborg, Mads Brix; Kisslo, Joseph; Søgaard, Peter

doi:10.1016/j.ahj.2012.01.025

Cited by 121 publications

(124 citation statements)

References 23 publications

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“…Furthermore, PSS occurs when other segments are relaxing and therefore impedes diastolic function. 12 The pathophysiology of LV LBBB electromechanical delay is related to increased wall stress in the prestretched lateral wall, 8 Our findings mirror this pathophysiology for the RV. 13 Hence, RBBB leads to early RV systolic abnormalities and late inefficient contraction.…”

Section: Electromechanical Dyssynchronysupporting

confidence: 74%

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Mechanisms of Right Ventricular Electromechanical Dyssynchrony and Mechanical Inefficiency in Children After Repair of Tetralogy of Fallot

Wang

Slorach

Dragulescu

et al. 2014

Circ: Cardiovascular Imaging

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Background-Right bundle branch block and right ventricular (RV) dysfunction are common after tetralogy of Fallot repair (rTOF). We hypothesized that right bundle branch block is associated with specific RV mechanical dyssynchrony and inefficient contraction. Methods and Results-We studied rTOF children and age-matched controls. QRS duration and morphology were assessed. RV mechanical dyssynchrony, indicated by early septal activation (right-sided septal flash), RV lateral wall prestretch/late contraction, postsystolic shortening, and intraventricular delay were analyzed using 2-dimensional strain echocardiography. Peak oxygen consumption reflected exercise capacity. Pulmonary regurgitation and RV volumes were assessed by MRI. Forty-six rTOF patients and 46 controls were studied. Ninety-three percent of rTOF patients demonstrated a right-sided septal flash with simultaneous RV basal lateral wall prestretch/late activation. The RV basal segment was the most delayed in onset (115 [0-194]

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Section: Electromechanical Dyssynchronysupporting

confidence: 74%

“…7 This drives global left ventricular (LV) dysfunction and ultimately morbidity and mortality 2 and also predicts a high response rate to cardiac resynchronization therapy (CRT). 7,8 Similarly, postsystolic shortening (PSS), caused by abnormal regional segmental interaction, is commonly associated with LV dysfunction but is not well described in the RV. 9 …”

mentioning

confidence: 99%

Mechanisms of Right Ventricular Electromechanical Dyssynchrony and Mechanical Inefficiency in Children After Repair of Tetralogy of Fallot

Wang

Slorach

Dragulescu

et al. 2014

Circ: Cardiovascular Imaging

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“…A regional strain pattern of early low septal strain and delayed lateral strain has recently been demonstrated to benefit most from CRT treatment, which might explain our finding. 43 However, this pattern has not previously been assessed in the relation to VT/VF events.…”

Section: 39mentioning

confidence: 99%

Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction

Knappe

Pouleur

Claggett

et al. 2017

Circ: Cardiovascular Imaging

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Background— Left ventricular dysfunction is a known predictor of ventricular arrhythmias. We hypothesized that measures of regional longitudinal deformation by speckle-tracking echocardiography predict ventricular tachyarrhythmias and provide incremental prognostic information over clinical and conventional echocardiographic characteristics. Methods and Results— We studied 1064 patients enrolled in the MADIT-CRT trial (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy) with speckle-tracking data available. Peak longitudinal strain was obtained for the septal, lateral, anterior, and inferior myocardial walls at baseline. The end point was the first event of ventricular tachycardia (VT) or fibrillation (VF). During the median follow-up of 2.9 years, 254 (24%) patients developed VT/VF. Patients with VT/VF had significantly lower left ventricular ejection fraction (28.3% versus 29.5%; P <0.001) and longitudinal strain in all myocardial walls compared with patients without VT/VF (anterior-strain, −7.7% versus −8.8%; P <0.001; lateral-strain, −7.3% versus −7.9%; P =0.022; inferior-strain, −8.3% versus −9.9%; P <0.001; septal-strain, −9.1% versus −10.0%; P <0.001). After multivariate adjustment, only anterior and inferior longitudinal strain remained independent predictors of VT/VF (anterior: hazard ratio, 1.08 [1.03–1.13]; P =0.001; inferior: hazard ratio, 1.08 [1.04–1.12]; P <0.001; per 1% absolute decrease for both). When including B-type natriuretic peptide in the model, only a decreasing myocardial function in the inferior myocardial wall predicted VT/VF (hazard ratio, 1.05 [1.00–1.11]; P =0.039). Only strain obtained from the inferior myocardial wall provided incremental prognostic information for VT/VF over clinical and echocardiographic parameters (C statistic 0.71 versus 0.69; P =0.005). Conclusions— Assessment of regional longitudinal myocardial deformation in the inferior region provided incremental prognostic information over clinical and echocardiographic risk factors in predicting ventricular tachyarrhythmias. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00180271.

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“…It has been well characterized that LBBB results in 2 phases of myocardial shortening followed by myocardial stretching or thinning. 9,12 An early septal…”

Section: Mechanical Discoordination and Wasted Energy From Lbbbmentioning

confidence: 99%

“…As the authors suggested, RSDc is one of many means to estimate the extent of wasted energy caused by conduction delay. While Risum et al 12 and Lim et al 11 used longitudinal strain, the investigators of the current article used radial strain imaging. Our group reported a different approach to quantify the extent of wasted energy using speckle-tracking radial strain and strain rate from the short axis view of the LV.…”

mentioning

confidence: 99%

Identification of Wasted Energy Is a Key to Predict Positive Response to Cardiac Resynchronization Therapy

Vatury

Wang

2013

Circ: Cardiovascular Imaging

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Simple regional strain pattern analysis to predict response to cardiac resynchronization therapy: Rationale, initial results, and advantages

Cited by 121 publications

References 23 publications

Mechanisms of Right Ventricular Electromechanical Dyssynchrony and Mechanical Inefficiency in Children After Repair of Tetralogy of Fallot

Mechanisms of Right Ventricular Electromechanical Dyssynchrony and Mechanical Inefficiency in Children After Repair of Tetralogy of Fallot

Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction

Identification of Wasted Energy Is a Key to Predict Positive Response to Cardiac Resynchronization Therapy

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