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J Am Coll Cardiol, 2008; 51:1944-1952, doi:10.1016/j.jacc.2008.02.040
© 2008 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: CARDIAC IMAGING

Assessment of Left Ventricular Dyssynchrony by Speckle Tracking Strain Imaging

Comparison Between Longitudinal, Circumferential, and Radial Strain in Cardiac Resynchronization Therapy

Victoria Delgado, MD, Claudia Ypenburg, MD, Rutger J. van Bommel, MD, Laurens F. Tops, MD, Sjoerd A. Mollema, MD, Nina Ajmone Marsan, MD, Gabe B. Bleeker, MD, PhD, Martin J. Schalij, MD, PhD and Jeroen J. Bax, MD, PhD*

Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.

Manuscript received September 17, 2007; revised manuscript received January 30, 2008, accepted February 4, 2008.

* Reprint requests and correspondence: Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands. (Email: j.j.bax{at}lumc.nl).

Objectives: The objective of this study was to assess the usefulness of each type of strain for left ventricular (LV) dyssynchrony assessment and its predictive value for a positive response after cardiac resynchronization therapy (CRT). Furthermore, changes in extent of LV dyssynchrony for each type of strain were evaluated during follow-up.

Background: Different echocardiographic techniques have been proposed for assessment of LV dyssynchrony. The novel 2-dimensional (2D) speckle tracking strain analysis technique can provide information on radial strain (RS), circumferential strain (CS), and longitudinal strain (LS).

Methods: In 161 patients, 2D echocardiography was performed at baseline and after 6 months of CRT. Extent of LV dyssynchrony was calculated for each type of strain. Response to CRT was defined as a decrease in LV end-systolic volume ≥15% at follow-up.

Results: At follow-up, 88 patients (55%) were classified as responders. Differences in baseline LV dyssynchrony between responders and nonresponders were noted only for RS (251 ± 138 ms vs. 94 ± 65 ms; p < 0.001), whereas no differences were noted for CS and LS. A cut-off value of radial dyssynchrony ≥130 ms was able to predict response to CRT with a sensitivity of 83% and a specificity of 80%. In addition, a significant decrease in extent of LV dyssynchrony measured with RS (from 251 ± 138 ms to 98 ± 92 ms; p < 0.001) was demonstrated only in responders.

Conclusions: Speckle tracking radial strain analysis constitutes the best method to identify potential responders to CRT. Reduction in LV dyssynchrony after CRT was only noted in responders.

Abbreviations and Acronyms
  2D = 2-dimensional
  AS-P = anteroseptal to posterior
  CRT = cardiac resynchronization therapy
  CS = circumferential strain
  LS = longitudinal strain
  LV = left ventricle/ventricular
  RS = radial strain
  SDt6s = standard deviation of time to peak-systolic strain of 6 segments
  SDt12s = standard deviation of time to peak-systolic strain of 12 segments
  TDI = tissue Doppler imaging


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