Tissue doppler imaging predicts improved systolic performance and reversed left ventricular remodeling during long-term cardiac resynchronization therapy
Peter Søgaard, MD, DMSc*,*,
Henrik Egeblad, MD, DMSc, FESC*,
W. Yong Kim, MD, PhD*,
Henrik K. Jensen, MD, PhD*,
Anders K. Pedersen, MD, DMSc*,
Bent Ø. Kristensen, MD, DMSc* and
Peter T. Mortensen, MD*
* Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Figure 1 Tissue Doppler image in the apical four-chamber view of a normal subject (upper left panel). (Right panel) The velocity profile during one cardiac cycle obtained at the base of the interventricular septum. The solid lines mark the duration of systole (310 ms), and the arrow indicates the peak systolic velocity (8 cm/s). The diastolic filling of the LV is reflected in the E-wave (E) and A-wave (A). (Lower left panel) Tissue tracking displays, in color-coded format, the regional myocardial shortening (mm) in each segment, calculated automatically as the integral of the digitally stored velocity tracing in systole in each segment.
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Figure 2 (A) Apical long-axis view in a patient with dilated cardiomyopathy and left bundle branch block. Solid lines mark the duration of systole (300 ms). The sample point is located at the base of the anteroseptal region. In this region, the peak velocity is 4 cm/s (arrow). (Lower left panel) Tissue tracking. From the color coding, it appears that the majority of the posterior wall is gray, indicating either no or paradoxical motion (i.e., motion away from the apex during systole). (B) The same patient as in part A, with the cursor positioned in the basal segment of the posterior wall. The interval between the solid lines in the right panel represents the duration (180 ms) of delayed longitudinal contraction (DLC), with a peak velocity of 6 cm/s (arrow). The onset of this DLC corresponds to the cessation of systole in the septum, as in part A, right panel. Tissue tracking (lower left panel) displays the extent of myocardium (colored segments) with DLC (diastole, open mitral valve). Note that the remaining part of the LV is gray, indicating either no motion or motion toward the base of the heart (relaxation). The strain rate is required to detect shortening or passive stretching.
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Figure 3 The same patient as in Figure 2. One sample (yellow) is positioned at the base of the septum and another (green) is located in the posterior wall. In each point, strain rate (SR) analysis is carried out in a range of 10 mm. The first solid line (right panel) represents the onset of a negative SR in the septum (yellow line), indicating the onset of systolic shortening. The second solid line indicates cessation of systole, where the SR in the septum becomes positive. At the same time, a negative SR is observed in the posterior wall (green line), and this persists between the second and third lines, documenting shortening in early diastole (i.e., delayed longitudinal contraction).
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Figure 4 The upper panels represent the three apical views in systole in a patient with idiopathic dilated cardiomyopathy before implantation of a biventricular pacemaker. The majority of the lateral wall, anterior wall and posterior wall are gray, indicating a lack of systolic motion toward the apex. The mechanical function of the interventricular septum and inferior walls is abnormal, with a higher motion amplitude in the segment adjacent to the apex (arrows). The lower panels show corresponding views after one year of cardiac resynchronization therapy. At this time, systolic motion toward the apex is present in the entire left ventricle. In addition, the reverse distribution of motion amplitude in the septum and inferior wall has been normalized, with greater systolic performance at the base of the left ventricle.
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Figure 5 (Left) Scatterplot showing the relationship between the percentage of the left ventricular (LV) base circumference exhibiting delayed longitudinal contraction (DLC) (x axis) and the percent change in global systolic contraction amplitude (GSCA) during follow-up. (Right) Scatterplot showing the relationship between the percentage of the LV base circumference exhibiting DLC (x axis) and the percent change in left ventricular ejection fraction (LVEF) during follow-up.
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