Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy

Bax, Jeroen J.; Bleeker, Gabe B.; Marwick, Thomas H.; Molhoek, Sander G.; Boersma, Eric; Steendijk, Paul; Wall, Ernst E. van der; Schalij, Martin J.

doi:10.1016/j.jacc.2004.08.016

Cited by 966 publications

(837 citation statements)

References 25 publications

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“…A Bland-Altman analysis was conducted to analyze the agreement between the two velocity measurement techniques (24). Dyssynchrony was assessed as the absolute difference between time to peak systolic velocity in the septal and lateral walls (13,(25)(26)(27). The repeatability of the MR and TDI data was assessed by comparing the peak velocity (both systolic and diastolic) and the time to peak velocity between repeated scans using a Bland-Altman analysis (24).…”

Section: Discussionmentioning

confidence: 99%

Comparison of myocardial velocities obtained with magnetic resonance phase velocity mapping and tissue doppler imaging in normal subjects and patients with left ventricular dyssynchrony

Delfino

Bhasin

Cole

et al. 2006

Magnetic Resonance Imaging

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Purpose: To compare longitudinal myocardial velocity and time to peak longitudinal velocity obtained with magnetic resonance phase velocity mapping (MR-PVM) and tissue Doppler imaging (TDI), and to assess the reproducibility of each method. Materials and Methods:Longitudinal myocardial velocity was measured by TDI and MR-PVM in 10 normal volunteers and 10 patients with dyssynchrony. The reproducibility of MR-PVM and TDI was assessed on repeated measurements in the 10 normal volunteers.Results: MR and TDI measurements of longitudinal myocardial velocity correlated well (r ϭ 0.86) in both normal subjects and patients with dyssynchrony. However, myocardial velocities measured with MR consistently exceeded velocities measured with TDI. MR and TDI agreed strongly in measuring the time to peak velocity (r ϭ 0.97). The reproducibility of TDI and MR-PVM appeared similar in measuring peak velocities (13.1% vs. 11.0%, respectively; P ϭ NS) and time to peak velocity (9.1% vs. 5.7%, respectively; P ϭ NS). Conclusion:Excellent correlation and reproducibility were observed between MR-PVM and TDI in measuring longitudinal myocardial velocity and time to peak velocity in both normal subjects and patients with dyssynchrony.

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Section: Discussionmentioning

confidence: 99%

Comparison of myocardial velocities obtained with magnetic resonance phase velocity mapping and tissue doppler imaging in normal subjects and patients with left ventricular dyssynchrony

Delfino

Bhasin

Cole

et al. 2006

Magnetic Resonance Imaging

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“…A systolic dyssynchrony index (SDI), calculated from tissue Doppler imaging (TDI), proved capable of retrospectively predicting enhanced clinical response in single-center work [83]. These benefits were also observed in a multicenter retrospective analysis where the use of baseline TDI imaging predicted not only functional and echocardiographic improvement but also identified patients who yielded prognostic benefit from CRT [84]. Speckle-tracking radial strain analysis superseded TDI, as it was less dependent on the angle of incidence of the ultrasound beam and also appeared able to predict echocardiographic response in retrospective analysis [85].…”

Section: Dyssynchrony Assessment and Identification Of The Site Of Lamentioning

confidence: 99%

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

Sieniewicz

Gould

Porter

et al. 2018

Expert Review of Medical Devices

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Introduction: Cardiac resynchronization therapy (CRT) has emerged as one of the few effective treatments for heart failure. However, up to 50% of patients derive no benefit. Suboptimal left ventricle (LV) lead position is a potential cause of poor outcomes while targeted lead deployment has been associated with enhanced response rates. Image-fusion guidance systems represent a novel approach to CRT delivery, allowing physicians to both accurately track and target a specific location during LV lead deployment.Areas covered: This review will provide a comprehensive evaluation of how to define the optimal pacing site. We will evaluate the evidence for delivering targeted LV stimulation at sites displaying favorable viability or advantageous mechanical or electrical properties. Finally, we will evaluate several emerging image-fusion guidance systems which aim to facilitate optimal site selection during CRT.Expert commentary: Targeted LV lead deployment is associated with reductions in morbidity and mortality. Assessment of tissue characterization and electrical latency are critical and can be achieved in a number of ways. Ultimately, the constraints of coronary sinus anatomy have forced the exploration of novel means of delivering CRT including endocardial pacing which hold promise for the future of CRT delivery.

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“…CTDI is most commonly used and measures time from QRS onset to peak systolic velocity (TPSV). Bax and colleagues defined dyssynchrony as the maximum difference in TPSV between the four basal (anterior, inferior, septal, lateral) segments 70 and TPSV difference of 65 ms had a sensitivity and specificity of 80% for predicting reduction in death and HF hospitalisation. Yu, et al developed a 12‐segment model involving six basal and mid segments from the three apical views and deriving the standard deviation (SD) between the 12 measurements, thereby creating a dyssynchrony index 71 .…”

Section: Newer Parameters and Applicationmentioning

confidence: 99%

“…Current guidelines 103 recommend CRT for patients on optimal medical therapy with EF ≤ 35%, in NYHA class III or IV with QRS ≥ 120 ms although a subgroup of patients with QRS < 120 ms can benefit from CRT 104 . Single centre studies of CRT response in HF found that improvement was more likely in patients with echocardiographic dyssynchrony at baseline 70 , 105 , 106 . However, two multicenter studies, the PROSPECT 107 and ReThinQ trials 108 , used echocardiographic criteria for patient selection and found only modest correlation between echocardiographic indices and CRT benefit.…”

Section: Role Of Echocardiography In Therapeutic Interventionmentioning

confidence: 99%

Echocardiographic evaluation of systolic heart failure

Thomas

2009

Australas J Ultrason Med

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Echocardiography is the most commonly used modality for evaluating left ventricular size and function in the context of systolic heart failure. Traditional techniques, though extensively used, have their limitations and more recently several newer technologies have emerged that are more reproducible, provide prognostic information, guide therapies and have an important role in monitoring progress. This review will evaluate the traditional and more novel techniques used and briefly provide an overview of the role of echocardiography in guiding and monitoring therapies in patients with systolic heart failure.

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Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy

Abstract: Patients with LV dyssynchrony >/=65 ms respond to CRT and have an excellent prognosis after CRT.

Cited by 966 publications

References 25 publications

Comparison of myocardial velocities obtained with magnetic resonance phase velocity mapping and tissue doppler imaging in normal subjects and patients with left ventricular dyssynchrony

Comparison of myocardial velocities obtained with magnetic resonance phase velocity mapping and tissue doppler imaging in normal subjects and patients with left ventricular dyssynchrony

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

Echocardiographic evaluation of systolic heart failure

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