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CLINICAL RESEARCH: CARDIAC RESYNCHRONIZATION THERAPY

Combined Longitudinal and Radial Dyssynchrony Predicts Ventricular Response After Resynchronization Therapy

John Gorcsan, III, MD, FACC^_*,1,_*, Masaki Tanabe, MD^_*, Gabe B. Bleeker, MD, Matthew S. Suffoletto, MD^_*, Nini C. Thomas, MD^_*, Samir Saba, MD, FACC^_*, Laurens F. Tops, MD, Martin J. Schalij, MD and Jeroen J. Bax, MD, FACC

^_* Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
Leiden University Medical Center, Leiden, the Netherlands.

Manuscript received April 26, 2007; revised manuscript received June 21, 2007, accepted June 25, 2007.

^_* Reprint requests and correspondence: Dr. John Gorcsan III, University of Pittsburgh, Scaife Hall 564, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213-2582. (Email: gorcsanj{at}upmc.edu).

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 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 (60 ms) and radial dyssynchrony (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.

Abbreviations and Acronyms   CI = confidence interval   CRT = cardiac resynchronization therapy   EF = ejection fraction   LV = left ventricular   NYHA = New York Heart Association   ROC = receiver operator characteristic   TDI = tissue Doppler imaging

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