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J Am Coll Cardiol, 2005; 45:677-684, doi:10.1016/j.jacc.2004.12.003
© 2005 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: VENTRICULAR DYSSYNCHRONY

A novel tool to assess systolic asynchrony and identify responders of cardiac resynchronization therapy by tissue synchronization imaging

Cheuk-Man Yu, MD, FRCP*,*, Qing Zhang, BM, MM*, Jeffrey Wing-Hong Fung, MRCP, FHKAM*, Hamish Chi-Kin Chan, MRCP, FHKAM{dagger}, Yat-Sun Chan, MRCP, FHKAM*, Gabriel Wai-Kwok Yip, MRCP, FHKAM*, Shun-Ling Kong, BN, MN*, Hong Lin, BM, MM*, Yan Zhang, BM* and John E. Sanderson, MD, FACC*

* Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
{dagger} Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China

Manuscript received April 29, 2004; revised manuscript received October 31, 2004, accepted November 11, 2004.

* Reprint requests and correspondence: Prof. Cheuk-Man Yu, Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, China. (Email: cmyu{at}cuhk.edu.hk).

OBJECTIVES: This study was designed to investigate if tissue synchronization imaging (TSI) is useful to identify regional wall delay and predict left ventricular (LV) reverse remodeling after cardiac resynchronization therapy (CRT).

BACKGROUND: Echocardiographic assessment of systolic asynchrony is helpful to predict a positive response to CRT. Tissue synchronization imaging is a new imaging technique that allows quick evaluation of regional systolic delay.

METHODS: Tissue synchronization imaging was performed in 56 heart failure patients at baseline and three months after CRT. Regional wall delay was identified on TSI images and the time to regional peak systolic velocity (Ts) in LV was measured by the six-basal-six-mid-segmental model. Eight TSI parameters of systolic asynchrony were computed when Ts was measured in ejection phase or also included postsystolic shortening.

RESULTS: Severe lateral wall delay occurred in 17 patients, which predicted LV reverse remodeling (chi-square = 8.13, p = 0.004). Among the eight quantitative parameters of asynchrony, the predictive values were higher for parameters that measured Ts in ejection phase than in postsystolic shortening. The standard deviation of Ts of 12 LV segments in ejection phase (Ts-SD-12-ejection) was most powerful to predict reverse remodeling (r = –0.61, p < 0.001) and gain in ejection fraction (r = 0.53, p < 0.001). The area of the receiver-operating characteristic (ROC) curve was the largest for Ts-SD-12-ejection (0.90, p < 0.001), with a sensitivity of 87% and specificity of 81% at a cutoff of 34.4 ms. The combination of lateral wall delay with Ts-SD-12-ejection gave a sensitivity and specificity of 82% and 87%.

CONCLUSIONS: Tissue synchronization imaging allows quick evaluation of regional wall delay, and combined with Ts-SD-12-ejection provides a reliable way of predicting reverse remodeling after CRT.

Abbreviations and Acronyms
  CRT = cardiac resynchronization therapy
  HF = heart failure
  LV = left ventricular/ventricle
  LVESV = left ventricular end-systolic volume
  PSS = post-systolic shortening
  ROC = receiver-operating characteristic
  TDI = tissue Doppler imaging
  TSI = tissue synchronization imaging
  Ts-SD-12-ejection = standard deviation of Ts of the 12 LV segments in ejection phase
  Ts-SD-6-ejection = standard deviation of Ts of the six basal LV segments in ejection phase
  Ts-12-ejection = maximal difference in Ts between any of the 2 out of 12 LV segments in ejection phase
  Ts-6-ejection = maximal difference in Ts between any of the 2 out of 6 basal LV segments in ejection phase
  2D = two-dimensional




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