Document Detail


Combined longitudinal and radial dyssynchrony predicts ventricular response after resynchronization therapy.
MedLine Citation:
PMID:  17919568     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The purpose of this study was to test the hypothesis that a combined echocardiographic assessment of longitudinal dyssynchrony by tissue Doppler imaging (TDI) and radial dyssynchrony by speckle-tracking strain may predict left ventricular (LV) functional response to cardiac resynchronization therapy (CRT). BACKGROUND: Mechanical LV dyssynchrony is associated with response to CRT; however, complex patterns may exist. METHODS: We studied 190 heart failure patients (ejection fraction [EF] 23 +/- 6%, QRS duration 168 +/- 27 ms) before and after CRT. Longitudinal dyssynchrony was assessed by color TDI for time to peak velocity (2 sites in all and 12 sites in a subgroup of 67). Radial dyssynchrony was assessed by speckle-tracking radial strain. The LV response was defined as > or =15% increase in EF. RESULTS: One hundred seventy-six patients (93%) had technically sufficient baseline and follow-up data available. Overall, 34% were EF nonresponders at 6 +/- 3 months after CRT. When both longitudinal dyssynchrony by 2-site TDI (> or =60 ms) and radial dyssynchrony (> or =130 ms) were positive, 95% of patients had an EF response; when both were negative, 21% had an EF response (p < 0.001 vs. both positive). The EF response rate was lowest (10%) when dyssynchrony was negative using 12-site TDI and radial strain (p < 0.001 vs. both positive). When either longitudinal or radial dyssynchrony was positive (but not both), 59% had an EF response. Combined longitudinal and radial dyssynchrony predicted EF response with 88% sensitivity and 80% specificity, which was significantly better than either technique alone (p < 0.0001). CONCLUSIONS: Combined patterns of longitudinal and radial dyssynchrony can be predictive of LV functional response after CRT.
Authors:
John Gorcsan; Masaki Tanabe; Gabe B Bleeker; Matthew S Suffoletto; Nini C Thomas; Samir Saba; Laurens F Tops; Martin J Schalij; Jeroen J Bax
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2007-09-24
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  50     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-08     Completed Date:  2007-10-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1476-83     Citation Subset:  AIM; IM    
Affiliation:
Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania 15213-2582, USA. gorcsanj@upmc.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiac Pacing, Artificial*
Echocardiography, Doppler / methods*
Electrophysiologic Techniques, Cardiac
Female
Heart Failure / physiopathology*,  therapy*
Humans
Male
Middle Aged
Prospective Studies
ROC Curve
Recovery of Function
Sensitivity and Specificity
Stroke Volume
Treatment Outcome
Ventricular Function, Left*
Ventricular Remodeling
Grant Support
ID/Acronym/Agency:
K24 HL04503-01/HL/NHLBI NIH HHS; R01 HL073198-01/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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