Mechanical dyssynchrony by 3D echo correlates with acute haemodynamic response to biventricular pacing in heart failure patients

Dijk, Jeroen van; Knaapen, Paul; Rüssel, Iris K.; Hendriks, T.; Allaart, Cornelis P.; Cock, Carel C. de; Kamp, Otto

doi:10.1093/europace/eum262

Cited by 42 publications

(31 citation statements)

References 21 publications

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“…18,19 Despite restricting analysis to patients with optimal images, we did not observe high predictive accuracy with this methodology. Limitations in temporal resolution with 3D echocardiography and poor reproducibility may have hindered accurate detection of dyssynchonous contraction and contributed to our findings.…”

Section: Is One Dyssynchrony Index Better Than Others?contrasting

confidence: 63%

Dyssynchrony Indices To Predict Response to Cardiac Resynchronization Therapy

Miyazaki

Redfield

Powell

et al. 2010

Circ: Heart Failure

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Background-Whether mechanical dyssynchrony indices predict reverse remodeling (RR) or clinical response to cardiac resynchronization therapy (CRT) remains controversial. This prospective study evaluated whether echocardiographic dyssynchrony indices predict RR or clinical response after CRT. Methods and Results-Of 184 patients with heart failure with anticipated CRT who were prospectively enrolled, 131 with wide QRS and left ventricular ejection fraction Ͻ35% had 6-month follow-up after CRT implantation. Fourteen dyssynchrony indices (feasibility) by M-mode (94%), tissue velocity (96%), tissue Doppler strain (92%), 2D speckle strain (65% to 86%), 3D echocardiography (79%), and timing intervals (98%) were evaluated. RR (end-systolic volume reduction Ն15%) occurred in 55% and more frequently in patients without (71%) than in patients with (42%) ischemic cardiomyopathy (Pϭ0.002). Overall, only M-mode, tissue Doppler strain, and total isovolumic time had a receiver operating characteristic area under the curve (AUC) greater than the line of no information, but none of these were strongly predictive of RR (AUC, 0.63 to 0.71). In nonischemic cardiomyopathy, no dyssynchrony index predicted RR.

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Section: Is One Dyssynchrony Index Better Than Others?contrasting

confidence: 63%

Dyssynchrony Indices To Predict Response to Cardiac Resynchronization Therapy

Miyazaki

Redfield

Powell

et al. 2010

Circ: Heart Failure

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“…It also has been suggested that longitudinal dyssynchrony may be subject to higher variability and may correlate less well with ventricular functional recovery after CRT than 2-dimensional strain techniques that evaluate radial dyssynchrony. 20 Other potentially interesting methods for further study are novel echocardiographic techniques, including 2-dimensional strain imaging (speckle tracking approach), 21 3-dimensional echocardiography, 22 anatomic M-mode imaging, 23 and magnetic resonance imaging. 24 Were the cutoff points for the echocardiographic measurements appropriately selected?…”

Section: Discussionmentioning

confidence: 99%

Results of the Predictors of Response to CRT (PROSPECT) Trial

et al. 2008

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Background-Data from single-center studies suggest that echocardiographic parameters of mechanical dyssynchrony may improve patient selection for cardiac resynchronization therapy (CRT). In a prospective, multicenter setting, the Predictors of Response to CRT (PROSPECT) study tested the performance of these parameters to predict CRT response. Methods and Results-Fifty-three centers in Europe, Hong Kong, and the United States enrolled 498 patients with standard CRT indications (New York Heart Association class III or IV heart failure, left ventricular ejection fraction Յ35%, QRS Ն130 ms, stable medical regimen). Twelve echocardiographic parameters of dyssynchrony, based on both conventional and tissue Doppler-based methods, were evaluated after site training in acquisition methods and blinded core laboratory analysis. Indicators of positive CRT response were improved clinical composite score and Ն15% reduction in left ventricular end-systolic volume at 6 months. Clinical composite score was improved in 69% of 426 patients, whereas left ventricular end-systolic volume decreased Ն15% in 56% of 286 patients with paired data. The ability of the 12 echocardiographic parameters to predict clinical composite score response varied widely, with sensitivity ranging from 6% to 74% and specificity ranging from 35% to 91%; for predicting left ventricular end-systolic volume response, sensitivity ranged from 9% to 77% and specificity from 31% to 93%. For all the parameters, the area under the receiver-operating characteristics curve for positive clinical or volume response to CRT was Յ0.62. There was large variability in the analysis of the dyssynchrony parameters. Conclusion-Given the modest sensitivity and specificity in this multicenter setting despite training and central analysis, no single echocardiographic measure of dyssynchrony may be recommended to improve patient selection for CRT beyond current guidelines. Efforts aimed at reducing variability arising from technical and interpretative factors may improve the predictive power of these echocardiographic parameters in a broad clinical setting. (Circulation. 2008;117: 2608-2616.)

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“…Three-dimensional echocardiography is another potential modality for quantification of dyssynchrony and prediction of the effect of CRT. 40,41 Several different mechanisms may be involved in CRT, and the best patient selection method may require several combined and/or stepwise approaches other than the single intraventricular dyssynchrony index.…”

Section: Prediction Of the Effect Of Crt By Assessment Of Strain-derimentioning

confidence: 99%

Strain Dyssynchrony Index Correlates With Improvement in Left Ventricular Volume After Cardiac Resynchronization Therapy Better Than Tissue Velocity Dyssynchrony Indexes

Miyazaki

Lin

Powell

et al. 2008

Circ: Cardiovascular Imaging

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Background-Various dyssynchrony indexes derived from tissue velocity and strain imaging have been proposed to predict the effectiveness of cardiac resynchronization therapy (CRT). We sought to compare the effect of CRT on dyssynchrony indexes derived by tissue velocity and strain and to determine which baseline intraventricular dyssynchrony parameters correlate with improvement in left ventricular volume after CRT. Methods and Results-Echocardiography with tissue Doppler imaging was performed in 45 patients with systolic heart failure at baseline, 1 day after CRT, and a median of 6 months after CRT. We calculated septal-lateral delay and anteroseptal-posterior delay and standard deviation of time to peak systolic velocity in the 12 basal and mid-left ventricular segments (Tv-SD). The standard deviation for time to peak strain in the 12 basal and mid-left ventricular segments (T-SD) was calculated as a strain-derived dyssynchrony index. None of the tissue velocity-derived dyssynchrony indexes improved after CRT (septal-lateral delay, Pϭ0.39; anteroseptal-posterior delay, Pϭ0.46; Tv-SD, Pϭ0.30), whereas T-SD decreased significantly after CRT (PϽ0.001). Improvement in T-SD 1 day after CRT correlated with the reduction in end-systolic volume at follow-up (rϭ0.66; PϽ0.001). Baseline T-SD demonstrated significant correlation with the reduction of end-systolic volume at follow-up (rϭ0.57; PϽ0.001); however, baseline tissue velocity-derived dyssynchrony indexes failed to predict the effect of CRT. Conclusions-The strain-derived dyssynchrony index is a better measurement than the tissue velocity dyssynchrony index for monitoring changes in mechanical dyssynchrony after CRT and for predicting reduction in left ventricular volume after CRT. (Circ Cardiovasc Imaging. 2008;1:14-22.)

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Mechanical dyssynchrony by 3D echo correlates with acute haemodynamic response to biventricular pacing in heart failure patients

Cited by 42 publications

References 21 publications

Dyssynchrony Indices To Predict Response to Cardiac Resynchronization Therapy

Dyssynchrony Indices To Predict Response to Cardiac Resynchronization Therapy

Results of the Predictors of Response to CRT (PROSPECT) Trial

Strain Dyssynchrony Index Correlates With Improvement in Left Ventricular Volume After Cardiac Resynchronization Therapy Better Than Tissue Velocity Dyssynchrony Indexes

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