Comparison of myocardial deformation and velocity dyssynchrony for identification of responders to cardiac resynchronization therapy

Abstract

AimsIt is unclear whether myocardial velocity or deformation indices of dyssynchrony are better at predicting response to cardiac resynchronization therapy (CRT). Therefore, two indices of left ventricular (LV) dyssynchrony based on myocardial velocity and deformation were compared to predict success of CRT. Methods and resultsSixty patients with dilated cardiomyopathy, New York Heart Association class III-IV, LV ejection fraction (EF) 35%, QRS .120 ms underwent CRT. The standard deviation of the averaged time-to-peak longitudinal negative strain (T1-SD) and positive systolic velocity (Tv-SD) of 12 LV segments were calculated before and after 6 months of CRT. Responders were defined at month 6 by !20% EF increase and/or !15% end-systolic volume (ESV) decrease with respect to baseline. On univariable analysis, baseline T1-SD and Tv-SD were both significantly associated with CRT response; however, the area under the receiver operating characteristic curve was better for T1-SD. On bivariable analysis, only T1-SD retained an independent prognostic value for CRT response. Results of the analysis did not change when the logistic models were adjusted for aetiology. ConclusionBaseline dyssynchrony of longitudinal myocardial peak deformation (T1-SD) appears to be better than dyssynchrony of longitudinal myocardial peak systolic velocities (Tv-SD) for the identification of CRT responders.--

Radial Strain Delay Based on Segmental Timing and Strain Amplitude Predicts Left Ventricular Reverse Remodeling and Survival After Cardiac Resynchronization Therapy

“…Although this result is in conflict with the study by Yu et al, 3 our findings are in line with more recent reports. Mele et al 19 report a comparison of tissue myocardial strain and velocity dyssynchrony and found that strain-derived regional timing of 12 nonapical segments better identified CRT responders. Likewise, Porciani et al 20 report a very low specificity of only 39% for the Tv-SD12 using a cutoff value of 33 milliseconds to predict response at the 6-month follow-up.…”

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

“…In addition, when all the various echocardiographic measures of mechanical dyssynchrony were analyzed in a large, international multicenter study, no single measure proved capable of improving patient selection for CRT [87]. Promisingly, newer techniques including longitudinal myocardial strain assessment [88] and 3D speckle-tracking echo [89] appear more reliable and indicate an encouraging direction for future work.…”

Positioning of Left Ventricular Pacing Lead Guided by Intracardiac Echocardiography with Vector Velocity Imaging During Cardiac Resynchronization Therapy Procedure

“…Our definition of CRT responder was in agreement with the standard criteria proposed by previous studies. Specifically, a positive response to resynchronization therapy was determined according to patient's functional status (defined as at least 1 class decrease of NYHA classification), cardiac performance (defined as relative increase in LV ejection fraction [EF] >20% from baseline) and reversing of LV remodeling (defined as more than 15% decrease of LV end‐systolic volume [LVESV]) 15–17 . To be qualified as a CRT responder, a patient had to fulfill at least 2 of the above 3 criteria.…”