Visual Assessment of Left Ventricular Dyssynchrony Using Tissue Synchronization Imaging

Abstract

Background: Tissue synchronizing imaging (TSI) allows visual detection of asynchronous myocardial contraction. Although it is a screening tool for the detection of left ventricular (LV) dyssynchrony, its use as a qualitative method to assess dyssynchrony has not been studied. We evaluated the correlation of the visual assessment of dyssynchrony using TSI with quantitative assessment, the value of visual assessment to predict reverse remodeling to cardiac resynchronization therapy (CRT). Methods: Echocardiograms from 100 consecutive patients were retrospectively evaluated. We compared visual TSI assessment with the qualitative assessment of dyssynchrony obtained by tissue Doppler imaging (TDI). The utility of visual assessment as a predictor of response to CRT was evaluated in 43 patients. Results: In 86% of the cases, visual assessment was possible, and reproducibility was unrelated to observer experience. Each grade of visual dyssynchrony corresponded to a range of values of time to peak velocity (TPV) gradient (p < 0.001). Grade ≥1 dyssynchrony by visual assessment had 90% sensitivity and 95% specificity to identify ≥65 ms TPV gradient of LV opposing walls, and 93% sensitivity and 70% specificity to predict reverse LV remodeling. Conclusion: LV dyssynchrony may be visually assessed by TSI, which can also predict reverse LV remodeling.

Differences in left ventricular dyssynchrony between high septal pacing and apical pacing in patients with normal left ventricular systolic function

“…Our study showed that TD-TDI in the high septal pacing group was significantly shorter than in the apical pacing group. Measurement of regional longitudinal myocardial electrical-mechanical events at the base of the heart using velocity data acquired with TDI has been proposed to enhance identification of mechanical dyssynchrony [7,15,18]. 2D-STE may be a superior approach, because TDI is particularly affected by translational and tethering effects, and angle-dependency [19].…”

Patients with Ankylosing Spondylitis Have Evidence of Left Ventricular Asynchrony

“…In the present study, we used TSI method which has been used previously for assessing ventricular synchronization with relatively good level of sensitivity and specificity. 22,35 There are some plausible mechanisms such as myocardial fibrosis, chronic inflammation, or cardiomyopathy that might underline the development of ventricular asynchrony in AS. [3][4][5]36 The myocardial fibrosis may impair the myocardial electrical coupling 9 and lead to asynchronous contractions.…”

“…There are different echocardiographic techniques available for the assessment of LV asynchrony such as TDI, TSI, and strain imaging. In the present study, we used TSI method which has been used previously for assessing ventricular synchronization with relatively good level of sensitivity and specificity 22,35 …”

Is Mechanical Dyssynchrony Assessment Better than Electrocardiogram for Predicting Cardiac Resynchronization Therapy Responder?

“…Based on this concept, a variety of echocardiographic methods have been studied, including M-mode, two-dimensional, spectral Doppler, tissue color Doppler imaging, three-dimensional echocardiography, strain and vector velocity imaging [7,8] . However, two recent randomized clinical trials did not demonstrate that mechanical dyssynchrony assessed by echocardiography is a reliable predictor of CRT responders [9,10] .In a recent issue of Cardiology , Biner et al [11] reports visual assessment of LV mechanical dyssynchrony in 86 patients including 43 patients receiving CRT. All the patients had wide QRS ( 1 120 ms), and more than half of the patients' QRS durations were more than 150 ms.…”