Circulation. 2006;113:960-968
Published online before print February 13, 2006, doi: 10.1161/CIRCULATIONAHA.105.571455
Published online before print February 13, 2006, doi: 10.1161/CIRCULATIONAHA.105.571455
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(Circulation. 2006;113:960-968.)
© 2006 American Heart Association, Inc.
Heart Failure |
Novel Speckle-Tracking Radial Strain From Routine Black-and-White Echocardiographic Images to Quantify Dyssynchrony and Predict Response to Cardiac Resynchronization Therapy
From The Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pa.
Correspondence to John Gorcsan III, MD, University of Pittsburgh, Scaife Hall 564, 200 Lothrop St, Pittsburgh, PA 15213-2582. E-mail gorcsanj{at}upmc.edu
Received June 24, 2005; revision received October 27, 2005; accepted December 2, 2005.
Background— Mechanical dyssynchrony is a potential means to predict response to cardiac resynchronization therapy (CRT). We hypothesized that novel echocardiographic image speckle tracking can quantify dyssynchrony and predict response to CRT.
Methods and Results— Seventy-four subjects were studied: 64 heart failure patients undergoing CRT (aged 64±12 years, ejection fraction 26±6%, QRS duration 157±28 ms) and 10 normal controls. Speckle tracking applied to routine midventricular short-axis images calculated radial strain from multiple circumferential points averaged to 6 standard segments. Dyssynchrony from timing of speckle-tracking peak radial strain was correlated with tissue Doppler measures in 47 subjects (r=0.94, P<0.001; 95% CI 0.90 to 0.96). The ability of baseline speckle-tracking radial dyssynchrony (time difference in peak septal wall–to–posterior wall strain 
130 ms) to predict response to CRT was then tested. It predicted an immediate increase in stroke volume in 48 patients studied the day after CRT with 91% sensitivity and 75% specificity. In 50 patients with long-term follow-up 8±5 months after CRT, baseline speckle-tracking radial dyssynchrony predicted a significant increase in ejection fraction with 89% sensitivity and 83% specificity. Patients in whom left ventricular lead position was concordant with the site of latest mechanical activation by speckle-tracking radial strain had an increase in ejection fraction from baseline to a greater degree (10±5%) than patients with discordant lead position (6±5%; P<0.05).
Conclusions— Speckle-tracking radial strain can quantify dyssynchrony and predict immediate and long-term response to CRT and has potential for clinical application.
CLINICAL PERSPECTIVE
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M. I Burgess, C. Jenkins, J. Chan, and T. H Marwick Measurement of left ventricular dyssynchrony in patients with ischaemic cardiomyopathy: a comparison of real-time three-dimensional and tissue Doppler echocardiography Heart, October 1, 2007; 93(10): 1191 - 1196. [Abstract] [Full Text] [PDF]
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G. B. Bleeker, S. A. Mollema, E. R. Holman, N. Van De Veire, C. Ypenburg, E. Boersma, E. E. van der Wall, M. J. Schalij, and J. J. Bax Left Ventricular Resynchronization Is Mandatory for Response to Cardiac Resynchronization Therapy: Analysis in Patients With Echocardiographic Evidence of Left Ventricular Dyssynchrony at Baseline Circulation, September 25, 2007; 116(13): 1440 - 1448. [Abstract] [Full Text] [PDF]
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L. F. Tops, M. S. Suffoletto, G. B. Bleeker, E. Boersma, E. E. van der Wall, J. Gorcsan III, M. J. Schalij, and J. J. Bax Speckle-Tracking Radial Strain Reveals Left Ventricular Dyssynchrony in Patients With Permanent Right Ventricular Pacing J. Am. Coll. Cardiol., September 18, 2007; 50(12): 1180 - 1188. [Abstract] [Full Text] [PDF]
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M. M. Henneman, J. Chen, P. Dibbets-Schneider, M. P. Stokkel, G. B. Bleeker, C. Ypenburg, E. E. van der Wall, M. J. Schalij, E. V. Garcia, and J. J. Bax Can LV Dyssynchrony as Assessed with Phase Analysis on Gated Myocardial Perfusion SPECT Predict Response to CRT? J. Nucl. Med., July 1, 2007; 48(7): 1104 - 1111. [Abstract] [Full Text] [PDF]
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T. Arita, G. P. Sorescu, B. T. Schuler, L. S. Schmarkey, J. D. Merlino, J. Vinten-Johansen, A. R. Leon, R. P. Martin, and D. Sorescu Speckle-tracking strain echocardiography for detecting cardiac dyssynchrony in a canine model of dyssynchrony and heart failure Am J Physiol Heart Circ Physiol, July 1, 2007; 293(1): H735 - H742. [Abstract] [Full Text] [PDF]
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Z. B. Popovic, C. Benejam, J. Bian, N. Mal, J. Drinko, K. Lee, F. Forudi, R. Reeg, N. L. Greenberg, J. D. Thomas, et al. Speckle-tracking echocardiography correctly identifies segmental left ventricular dysfunction induced by scarring in a rat model of myocardial infarction Am J Physiol Heart Circ Physiol, June 1, 2007; 292(6): H2809 - H2816. [Abstract] [Full Text] [PDF]
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M. Becker, R. Kramann, A. Franke, O.-A. Breithardt, N. Heussen, C. Knackstedt, C. Stellbrink, P. Schauerte, M. Kelm, and R. Hoffmann Impact of left ventricular lead position in cardiac resynchronization therapy on left ventricular remodelling. A circumferential strain analysis based on 2D echocardiography Eur. Heart J., May 2, 2007; 28(10): 1211 - 1220. [Abstract] [Full Text] [PDF]
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G. B. Bleeker, M. J. Schalij, and J. J. Bax Importance of left ventricular lead position in cardiac resynchronization therapy Eur. Heart J., May 2, 2007; 28(10): 1182 - 1183. [Full Text] [PDF]
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A. E. Weyman The Year in Echocardiography J. Am. Coll. Cardiol., March 20, 2007; 49(11): 1212 - 1219. [Full Text] [PDF]
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R. H. Helm, M. Byrne, P. A. Helm, S. K. Daya, N. F. Osman, R. Tunin, H. R. Halperin, R. D. Berger, D. A. Kass, and A. C. Lardo Three-Dimensional Mapping of Optimal Left Ventricular Pacing Site for Cardiac Resynchronization Circulation, February 27, 2007; 115(8): 953 - 961. [Abstract] [Full Text] [PDF]
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J. D. Thomas and Z. B. Popovic Assessment of Left Ventricular Function by Cardiac Ultrasound J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2012 - 2025. [Abstract] [Full Text] [PDF]
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O.-A. Breithardt and G. Breithardt Quest for the Best Candidate: How Much Imaging Do We Need Before Prescribing Cardiac Resynchronization Therapy? Circulation, February 21, 2006; 113(7): 926 - 928. [Full Text] [PDF]
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