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Septal to Posterior Wall Motion Delay Fails to Predict Reverse Remodeling or Clinical Improvement in Patients Undergoing Cardiac Resynchronization Therapy

Gregory M. Marcus, MD^_*, Emily Rose, MD, Esperanza M. Viloria, BS^_*, Jill Schafer, MS, Teresa De Marco, MD, FACC^_*, Leslie A. Saxon, MD, FACC, Elyse Foster, MD, FACC^_*,_* for the VENTAK CHF/CONTAK-CD Biventricular Pacing Study Investigators

^_* Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California
Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
Guidant Corporation, St. Paul, Minnesota
Department of Medicine, Division of Cardiology, University of Southern California, Los Angeles, California

View larger version (112K): [in a new window]   Figure 1 Septal wall motion delay (SWMD) was measured in M-mode by measuring from the start of the QRS to the peak of the septal wall deflection. Posterior wall motion delay (PWMD) was measured similarly by measuring from the start of the QRS to the peak of the posterior wall deflection. The difference between the septal wall deflection and the posterior wall deflection is the septal-to-posterior wall motion delay (SPWMD).

View larger version (142K): [in a new window]   Figure 2 This figure illustrates the ambiguous nature of the septal-to-posterior wall motion delay (SPWMD) measurement even when both walls were well visualized. It is uncertain whether the septal wall deflection should be measured at A, the first deflection, at B, the middle of the larger area of deflection, or at point C where the maximum deflection is seen. The initial septal wall deflection is too close to the QRS to represent contraction and may reflect posterior motion resulting from ventricular interaction. The middle of the larger area of septal wall deflection is appropriately timed while the maximum septal wall deflection occurs in diastole.