Assessment of Left Ventricular Dyssynchrony by Speckle Tracking Strain ImagingComparison Between Longitudinal, Circumferential, and Radial Strain in Cardiac Resynchronization Therapy
Victoria Delgado, MD,
Claudia Ypenburg, MD,
Rutger J. van Bommel, MD,
Laurens F. Tops, MD,
Sjoerd A. Mollema, MD,
Nina Ajmone Marsan, MD,
Gabe B. Bleeker, MD, PhD,
Martin J. Schalij, MD, PhD and
Jeroen J. Bax, MD, PhD*
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
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Figure 1 Two-Dimensional Strain Imaging
In the left panels, the 2-dimensional strain images are represented. The arrows depict the type of deformation assessed in each view: radial thickening (A), circumferential shortening (B), and longitudinal shortening (C). The middle and right panels demonstrate the segmental time-strain curves for a synchronous (middle panels) and dyssynchronous (right panels) left ventricle for each view. Time differences in peak-systolic strain (t) between anteroseptal (AS) and posterior (P) segments, in short-axis view, and between basal-septal (BS) and basal-lateral (BL) segments, in 4-chamber view, can be obtained from these curves.
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Figure 2 Changes in LVEDV, LVESV, and LVEF During Follow-Up According to CRT Response
(A) Left ventricular end-diastolic volume (LVEDV); (B) left ventricular end-systolic volume (LVESV); (C) left ventricular ejection fraction (LVEF). Solid bars = baseline values, open bars = 6-month follow-up values. CRT = cardiac resynchronization therapy.
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Figure 3 Relationship Between Baseline AS-P Delay and SDt6S and LV Reverse Remodeling After 6 Months of CRT
(A) Anteroseptal to posterior (AS-P); (B) standard deviation of time to peak-systolic strain of 6 segments (SDt6s). LV = left ventricular; RS = radial strain; other abbreviations as in Figure 2.
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Figure 4 Changes in LV Dyssynchrony as Assessed With RS, CS, and LS After Cardiac Resynchronization Therapy in Responders and Nonresponders
(A and B) RS; (C and D) circumferential strain (CS); (E, F) longitudinal strain (LS). Solid bars = baseline values, open bars = values at 6-month follow-up. BS-BL delay = difference between time to peak systolic strain of the basal-septal and basal-lateral segments; SDt125 = standard deviation of the time to peak systolic strain of 12 segments; other abbreviations as in Figure 3.
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Figure 5 Receiver-Operating Characteristic Curves for AS-P Delay and SDt6S by RS and LV Dyssynchrony by TDI
(A) AS-P delay; (B) SDt6S; (C) assessed by RS and LV dyssynchrony. AUC = area under the curve; TDI = tissue Doppler imaging; other abbreviations as in Figures 3 and 4.
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