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A novel tool to assess systolic asynchrony and identify responders of cardiac resynchronization therapy by tissue synchronization imaging

Cheuk-Man Yu, MD, FRCP^*,*, Qing Zhang, BM, MM^*, Jeffrey Wing-Hong Fung, MRCP, FHKAM^*, Hamish Chi-Kin Chan, MRCP, FHKAM, Yat-Sun Chan, MRCP, FHKAM^*, Gabriel Wai-Kwok Yip, MRCP, FHKAM^*, Shun-Ling Kong, BN, MN^*, Hong Lin, BM, MM^*, Yan Zhang, BM^* and John E. Sanderson, MD, FACC^*

^* Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China

View larger version (77K): [in a new window]   Figure 1 Tissue synchronization imaging (TSI) on three apical views showing the presence of extensive regional wall delay in a heart failure patient with prolonged QRS duration. The TSI method was set up to measure the time to peak myocardial systolic velocity (Ts) at ejection phase. The Ts values were then transformed into various color coding depending on the severity of delay, in the sequence of green, yellow, orange, and red. (A) Before cardiac resynchronization therapy (CRT), this patient had severe delay over the basal to mid-lateral wall and the whole septal wall (red color in four-chamber view), severe delay over the whole inferior wall (red color in two-chamber view), and moderate to severe delay over the whole posterior wall (orange to red color in long-axis view). (B) Three months after CRT, corresponding views showed dramatic improvement of these delays, with only mild residual delay over the lateral and inferior wall (green to yellow). The cine loops of TSI images at four-chamber view before and after CRT are available online at www.onlinejacc.org.

View larger version (20K): [in a new window]   Figure 2 The relationship between Ts (A) and Ts-SD (B) measured by myocardial velocity curve of tissue Doppler imaging and tissue synchronization imaging (TSI) in ejection phase. Ts = time to peak myocardial systolic velocity; Ts-SD = standard deviation of time to peak myocardial systolic velocity of the 12 left ventricular segments.

View larger version (24K): [in a new window]   Figure 3 A scatter plot of the change in left ventricular end-systolic volume (LVVs) and severity of systolic asynchrony as measured by the following tissue synchronization imaging (TSI) parameters. (A) Ts-SD-12-ejection; (B) Ts-SD-12-PSS; (C) Ts-SD-6-ejection; (D) Ts-SD-6-PSS.

View larger version (25K): [in a new window]   Figure 4 The receiver-operating characteristic curves for identification of left ventricular reverse remodeling in patients who received cardiac resynchronization therapy for the following tissue synchronization imaging parameters. (A) Ts-SD-12-ejection; (B) Ts-SD-12-PSS; (C) Ts-SD-6-ejection; (D) Ts-SD-6-PSS.

View larger version (22K): [in a new window]   Figure 5 Suggested algorithm for assessing systolic asynchrony by tissue synchronization imaging (TSI) to predict reverse remodeling. 2D = two-dimensional; SD = standard deviation.