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Assessment of Left Ventricular Dyssynchrony in Patients With Conduction Delay and Idiopathic Dilated Cardiomyopathy

Head-to-Head Comparison Between Tissue Doppler Imaging and Velocity-Encoded Magnetic Resonance Imaging

Jos J.M. Westenberg, PhD^_*,,_*, Hildo J. Lamb, MD, PhD, Rob J. van der Geest, MSc^_*,, Gabe B. Bleeker, MD, Eduard R. Holman, MD, PhD, Martin J. Schalij, MD, PhD, Albert de Roos, MD, PhD, Ernst E. van der Wall, MD, PhD, Johan H.C. Reiber, PhD^_*, and Jeroen J. Bax, MD, PhD

^_* Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.

View larger version (101K): [in a new window]   Figure 1 Example of the assessment of left ventricular (LV) dyssynchrony in a normal individual. In the color-coded tissue Doppler images (TDI) (A, four-chamber view), sample volumes are placed in the basal part of the septum and lateral wall. Velocity graphs derived from the velocities measured in these sample volumes are presented in the right panel of A. In this normal individual, LV dyssynchrony is not present, as indicated by a septal-to-lateral delay in peak systolic velocity (arrow) of 0 ms. (B) The accompanying velocity encoded magnetic resonance imaging is presented. Similar to TDI, sample volumes are placed at the basal level of the septum and lateral wall. The velocity graphs are presented in panel C, confirming the absence of LV dyssynchrony (septal-to-lateral delay 0 ms).

View larger version (107K): [in a new window]   Figure 2 Example of left ventricular (LV) dyssynchrony assessment in a patient. (A) The color-coded tissue Doppler images four-chamber view. The velocity graphs are presented in the right panel of A. There is extensive LV dyssynchrony with a septal-to-lateral delay in peak systolic velocities of 115 ms (arrows). The accompanying velocity encoded magnetic resonance imaging and velocity graphs are presented in panels B and C, respectively, confirming extensive LV dyssynchrony with a septal-to-lateral delay of 116 ms.

View larger version (15K): [in a new window]   Figure 3 Correlation between magnetic resonance imaging (MRI) and tissue Doppler images (TDI) for assessment of left ventricular (LV) dyssynchrony. (A) The extent of LV dyssynchrony measured with MRI is plotted against LV dyssynchrony measured with TDI for both patients and normal individuals. For seven normal individuals and two patients, no dyssynchrony was noted on either TDI or MRI, showing coinciding markers in (0,0). Linear regression for all data resulted in a strong linear relation between MRI and TDI (Y = 0.99X – 4.9, n = 30, r = 0.98, p < 0.01). The differences between MRI and TDI (Bland-Altman analysis) are presented in (B). The MRI showed a small nonsignificant underestimation of 5 ± 8 ms for LV dyssynchrony as compared with TDI (dashed lines). The confidence intervals ranged from –22 ms to 11 ms (dotted lines).