CLINICAL RESEARCH: CARDIAC RESYNCHRONIZATION THERAPY
Combined Longitudinal and Radial Dyssynchrony Predicts Ventricular Response After Resynchronization Therapy
John Gorcsan, III, MD, FACC*,*,
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.
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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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Postgrad. Med. J.,
February 1, 2012;
88(1036):
105 - 112.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Carluccio, P. Biagioli, G. Alunni, A. Murrone, P. Pantano, E. Biscottini, C. Zuchi, G. Zingarini, C. Cavallini, and G. Ambrosio
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J. Am. Coll. Cardiol. Img.,
October 1, 2011;
4(10):
1067 - 1076.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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Eur Heart J Cardiovasc Imaging,
October 1, 2011;
12(10):
782 - 789.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Gorcsan III and H. Tanaka
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J. Am. Coll. Cardiol.,
September 27, 2011;
58(14):
1401 - 1413.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Edvardsen and K. H. Haugaa
Imaging assessment of ventricular mechanics
Heart,
August 15, 2011;
97(16):
1349 - 1356.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Knappe, A.-C. Pouleur, A. M. Shah, S. Cheng, H. Uno, W. J. Hall, M. Bourgoun, E. Foster, W. Zareba, I. Goldenberg, et al.
Dyssynchrony, Contractile Function, and Response to Cardiac Resynchronization Therapy
Circ Heart Fail,
July 1, 2011;
4(4):
433 - 440.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Tanaka, M. Tanabe, M. A. Simon, R. C. Starling, D. Markham, V. Thohan, P. Mather, D. M. McNamara, and J. Gorcsan III
Left Ventricular Mechanical Dyssynchrony in Acute Onset Cardiomyopathy: Association of Its Resolution With Improvements in Ventricular Function
J. Am. Coll. Cardiol. Img.,
May 1, 2011;
4(5):
445 - 456.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Q. Zhang, R. J. van Bommel, Y.-S. Chan, V. Delgado, Y. Liang, M. J. Schalij, J. J. Bax, F. Fang, G. Wai-Kwok Yip, and C.-M. Yu
Diverse patterns of longitudinal and radial dyssynchrony in patients with advanced systolic heart failure
Heart,
April 1, 2011;
97(7):
574 - 578.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Lamia, M. Tanabe, H. Tanaka, H. K. Kim, J. Gorcsan III, and M. R. Pinsky
Left ventricular systolic torsion correlates global cardiac performance during dyssynchrony and cardiac resynchronization therapy
Am J Physiol Heart Circ Physiol,
March 1, 2011;
300(3):
H853 - H858.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Mor-Avi, R. M. Lang, L. P. Badano, M. Belohlavek, N. M. Cardim, G. Derumeaux, M. Galderisi, T. Marwick, S. F. Nagueh, P. P. Sengupta, et al.
Current and Evolving Echocardiographic Techniques for the Quantitative Evaluation of Cardiac Mechanics: ASE/EAE Consensus Statement on Methodology and Indications Endorsed by the Japanese Society of Echocardiography
Eur Heart J Cardiovasc Imaging,
March 1, 2011;
12(3):
167 - 205.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Delgado and J. J. Bax
Assessment of Systolic Dyssynchrony for Cardiac Resynchronization Therapy Is Clinically Useful
Circulation,
February 15, 2011;
123(6):
640 - 655.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. K. Sung and E. Foster
Assessment of Systolic Dyssynchrony for Cardiac Resynchronization Therapy Is Not Clinically Useful
Circulation,
February 15, 2011;
123(6):
656 - 662.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Gorcsan III
Finding Pieces of the Puzzle of Nonresponse to Cardiac Resynchronization Therapy
Circulation,
January 4, 2011;
123(1):
10 - 12.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. C. Adelstein, H. Tanaka, P. Soman, G. Miske, S. C. Haberman, S. F. Saba, and J. Gorcsan III
Impact of scar burden by single-photon emission computed tomography myocardial perfusion imaging on patient outcomes following cardiac resynchronization therapy
Eur. Heart J.,
January 1, 2011;
32(1):
93 - 103.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. J. van Bommel, H. Tanaka, V. Delgado, M. Bertini, C. J. W. Borleffs, N. Ajmone Marsan, J. Holzmeister, F. Ruschitzka, M. J. Schalij, J. J. Bax, et al.
Association of intraventricular mechanical dyssynchrony with response to cardiac resynchronization therapy in heart failure patients with a narrow QRS complex
Eur. Heart J.,
December 2, 2010;
(2010)
ehq334v2.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Gorcsan III, O. Oyenuga, P. J. Habib, H. Tanaka, E. C. Adelstein, H. Hara, D. M. McNamara, and S. Saba
Relationship of Echocardiographic Dyssynchrony to Long-Term Survival After Cardiac Resynchronization Therapy
Circulation,
November 9, 2010;
122(19):
1910 - 1918.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C.-M. Yu, J. E. Sanderson, and J. Gorcsan III
Echocardiography, dyssynchrony, and the response to cardiac resynchronization therapy
Eur. Heart J.,
October 1, 2010;
31(19):
2326 - 2337.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Tanaka, H.-J. Nesser, T. Buck, O. Oyenuga, R. A. Janosi, S. Winter, S. Saba, and J. Gorcsan III
Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy: results of the Speckle Tracking and Resynchronization (STAR) study
Eur. Heart J.,
July 2, 2010;
31(14):
1690 - 1700.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. K. Fornwalt, W. W. Sprague, P. BeDell, J. D. Suever, B. Gerritse, J. D. Merlino, D. A. Fyfe, A. R. Leon, and J. N. Oshinski
Agreement Is Poor Among Current Criteria Used to Define Response to Cardiac Resynchronization Therapy
Circulation,
May 11, 2010;
121(18):
1985 - 1991.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Tanaka, H. Hara, E. C. Adelstein, D. Schwartzman, S. Saba, and J. Gorcsan III
Comparative Mechanical Activation Mapping of RV Pacing to LBBB by 2D and 3D Speckle Tracking and Association With Response to Resynchronization Therapy
J. Am. Coll. Cardiol. Img.,
May 1, 2010;
3(5):
461 - 471.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. E. Park, S. A. Chang, H. K. Kim, D. H. Shin, J. H. Kim, M. K. Seo, Y. J. Kim, G. Y. Cho, D. W. Sohn, B. H. Oh, et al.
Impact of Loading Condition on the 2D Speckle Tracking-Derived Left Ventricular Dyssynchrony Index in Nonischemic Dilated Cardiomyopathy
Circ Cardiovasc Imaging,
May 1, 2010;
3(3):
272 - 281.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
O. Oyenuga, H. Hara, H. Tanaka, H.-N. Kim, E. C. Adelstein, S. Saba, and J. Gorcsan III
Usefulness of Echocardiographic Dyssynchrony in Patients With Borderline QRS Duration to Assist With Selection for Cardiac Resynchronization Therapy
J. Am. Coll. Cardiol. Img.,
February 1, 2010;
3(2):
132 - 140.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Lafitte, P. Reant, A. Zaroui, E. Donal, A. Mignot, H. Bougted, H. Belghiti, P. Bordachar, A. Deplagne, J. Chabaneix, et al.
Validation of an echocardiographic multiparametric strategy to increase responders patients after cardiac resynchronization: a multicentre study
Eur. Heart J.,
December 1, 2009;
30(23):
2880 - 2887.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Tanaka, H. Kawai, K. Tatsumi, T. Kataoka, T. Onishi, A. Yoshida, and K.-i. Hirata
Large response to cardiac resynchronization therapy in a patient with segmental paradoxical systolic expansion identified by strain imaging
Eur Heart J Cardiovasc Imaging,
October 1, 2009;
10(7):
889 - 892.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. C. Govind, A. S. Gopal, A. Netyo, J. Nowak, L.-A. Brodin, A. Patrianakos, S.S. Ramesh, and S. Saha
Quantification of low-dose dobutamine stress using speckle tracking echocardiography in coronary artery disease
Eur Heart J Cardiovasc Imaging,
July 1, 2009;
10(5):
607 - 612.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Janousek
Cardiac resynchronisation in congenital heart disease
Heart,
June 1, 2009;
95(11):
940 - 947.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Bax and J. Gorcsan III
Echocardiography and Noninvasive Imaging in Cardiac Resynchronization Therapy: Results of the PROSPECT (Predictors of Response to Cardiac Resynchronization Therapy) Study in Perspective
J. Am. Coll. Cardiol.,
May 26, 2009;
53(21):
1933 - 1943.
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. M. Hawkins, M. C. Petrie, M. I. Burgess, and J. J.V. McMurray
Selecting Patients for Cardiac Resynchronization Therapy: The Fallacy of Echocardiographic Dyssynchrony
J. Am. Coll. Cardiol.,
May 26, 2009;
53(21):
1944 - 1959.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. E. Sanderson
Echocardiography for Cardiac Resynchronization Therapy Selection: Fatally Flawed or Misjudged?
J. Am. Coll. Cardiol.,
May 26, 2009;
53(21):
1960 - 1964.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. F. Tops and J. J. Bax
The Year in Imaging Related to Electrophysiology
J. Am. Coll. Cardiol. Img.,
April 1, 2009;
2(4):
498 - 510.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. Mullens, R. A. Grimm, T. Verga, T. Dresing, R. C. Starling, B. L. Wilkoff, and W.H. W. Tang
Insights From a Cardiac Resynchronization Optimization Clinic as Part of a Heart Failure Disease Management Program
J. Am. Coll. Cardiol.,
March 3, 2009;
53(9):
765 - 773.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. Mullens, T. Verga, R. A. Grimm, R. C. Starling, B. L. Wilkoff, and W.H. W. Tang
Persistent Hemodynamic Benefits of Cardiac Resynchronization Therapy With Disease Progression in Advanced Heart Failure
J. Am. Coll. Cardiol.,
February 17, 2009;
53(7):
600 - 607.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. T. Esch and D. E. R. Warburton
Left ventricular torsion and recoil: implications for exercise performance and cardiovascular disease
J Appl Physiol,
February 1, 2009;
106(2):
362 - 369.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Marcucci, R. Lauer, and A. Mahajan
New Echocardiographic Techniques for Evaluating Left Ventricular Myocardial Function
Seminars in Cardiothoracic and Vascular Anesthesia,
December 1, 2008;
12(4):
228 - 247.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. Gupta, F. Khan, M. Shapiro, S. G. Weeks, S. E. Litwin, and A. D. Michaels
The associations between tricuspid annular plane systolic excursion (TAPSE), ventricular dyssynchrony, and ventricular interaction in heart failure patients
Eur Heart J Cardiovasc Imaging,
November 1, 2008;
9(6):
766 - 771.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. A. Marsan, O. A. Breithardt, V. Delgado, M. Bertini, and L. F. Tops
Predicting response to CRT. The value of two- and three-dimensional echocardiography
Europace,
November 1, 2008;
10(suppl_3):
iii73 - iii79.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Gorcsan III and M. S. Suffoletto
The role of tissue Doppler and strain imaging in predicting response to CRT
Europace,
November 1, 2008;
10(suppl_3):
iii80 - iii87.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Gorcsan III
Is the magnet a better crystal ball for predicting response to cardiac resynchronization therapy?
J. Am. Coll. Cardiol. Img.,
September 1, 2008;
1(5):
569 - 571.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. O. Sweeney and F. W. Prinzen
Ventricular Pump Function and Pacing: Physiological and Clinical Integration
Circ Arrhythm Electrophysiol,
June 1, 2008;
1(2):
127 - 139.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Delgado, C. Ypenburg, R. J. van Bommel, L. F. Tops, S. A. Mollema, N. A. Marsan, G. B. Bleeker, M. J. Schalij, and J. J. Bax
Assessment of Left Ventricular Dyssynchrony by Speckle Tracking Strain Imaging: Comparison Between Longitudinal, Circumferential, and Radial Strain in Cardiac Resynchronization Therapy
J. Am. Coll. Cardiol.,
May 20, 2008;
51(20):
1944 - 1952.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
O. I.I. Soliman, M. L. Geleijnse, and F. J. ten Cate
Echocardiographic selection of candidates for cardiac resynchronization therapy: the lack of evidence!
Eur Heart J Cardiovasc Imaging,
May 1, 2008;
9(3):
319 - 320.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. E. Weyman
The Year in Echocardiography
J. Am. Coll. Cardiol.,
March 25, 2008;
51(12):
1221 - 1229.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, P. Clopton, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, J. D. Knoke, W. Y.W. Lew, J. A.C. Lima, et al.
Highlights of the Year in JACC 2007
J. Am. Coll. Cardiol.,
January 29, 2008;
51(4):
490 - 512.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. F. Nagueh
Mechanical Dyssynchrony in Congestive Heart Failure: Diagnostic and Therapeutic Implications
J. Am. Coll. Cardiol.,
January 1, 2008;
51(1):
18 - 22.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
