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Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony

Maria Vittoria Pitzalis, MD, PhD^*,*, Massimo Iacoviello, MD^*, Roberta Romito, MD, Francesco Massari, MD, Brian Rizzon, MD^*, Giovanni Luzzi, MD^*, Pietro Guida, MS^*, Andrea Andriani, MD^*, Filippo Mastropasqua, MD and Paolo Rizzon, MD^*

^* Institute of Cardiology, University of Bari, Bari, Italy
Cardiology, "S. Maugeri" Foundation, IRCCS, Cassano Murge, Bari, Italy

View larger version (106K): [in a new window]   Figure 1 Mono-dimensional short-axis view of the echocardiographic image taken at the level of the papillary muscles. Calculation of septal-to-posterior wall motion delay (SPWMD) obtained by measuring the shortest interval between the maximal posterior displacement of the septum (a) and the posterior wall (b).

View larger version (101K): [in a new window]   Figure 2 Two-dimensional apical four-chamber view of echocardiographic images. Left ventricular end-systolic volumes before (pre) device implantation (left images) and one month after cardiac resynchronization therapy (right images) in two different patients. (A) This patient had a prolonged pre-implantation septal-to-posterior wall motion delay (SPWMD) and a marked left ventricular end-systolic volume reduction after one month. (B) This patient had a short pre-implantation SPWMD and no reverse remodeling.

View larger version (19K): [in a new window]   Figure 3 (Top) The correlation between the baseline values of septal-to-posterior wall motion delay (SPWMD) and LVESVI. (Bottom) Correlation between baseline QRS duration and LVESVI. LVESVI = difference between post- and pre-implantation left ventricular end-systolic volumes indexed for body surface area.

View larger version (23K): [in a new window]   Figure 4 The receiver operating characteristic curves for septal-to-posterior wall motion delay (SPWMD), PQ interval, and QRS duration to predict reverse remodeling. The areas underlying SPWMD and QRS duration are statistically different.