Combined Longitudinal and Radial Dyssynchrony Predicts Ventricular Response After Resynchronization Therapy
John Gorcsan, III, MD, FACC*,*,
Masaki Tanabe, MD*,
Gabe B. Bleeker, MD ,
Matthew S. Suffoletto, MD*,
Nini C. Thomas, MD*,
Samir Saba, MD, FACC*,
Laurens F. Tops, MD,
Martin J. Schalij, MD and
Jeroen J. Bax, MD, FACC
* Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
Leiden University Medical Center, Leiden, the Netherlands
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Figure 1 Combined Analysis in a Patient With Significant Dyssynchrony Prior to Resynchronization Therapy
(Top) Tissue Doppler time-velocity curves were derived from 12 sites: basal and mid levels from apical 4-chamber, 2-chamber, and long-axis views. Representative paired curves from 6 sites are shown illustrating a significant opposing wall delay of 110 ms (white arrows). (Bottom) Speckle-tracking time-strain curves of 6 radial sites are shown from the midventricular short-axis view with a significant anterior septum to posterior wall delay of 310 ms (yellow and purple arrows). AVC = aortic valve closing; AVO = aortic valve opening.
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Figure 2 Combined Analysis in a Patient With No Significant Dyssynchrony Prior to Resynchronization Therapy
(Top) Tissue Doppler time-velocity curves derived from 12 sites: basal and mid levels from apical 4-chamber, 2-chamber, and long-axis views. The maximum opposing wall delay of only 50 ms was not considered to be significant (white arrows). (Bottom) Speckle-tracking time-strain curves of 6 radial sites are shown from the midventricular short-axis view. The maximum opposing wall delay of only 85 ms was not considered to be significant (yellow and purple arrows). Abbreviations as in Figure 1.
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Figure 3 Receiver-Operating Characteristic Curves for Individual Dyssynchrony Methods and the Combined Method
The comparison with the 2-site tissue Doppler longitudinal dyssynchrony data appears on the left, and the comparison with radial dyssynchrony by speckle-tracking radial strain appears on the right. The areas under the curves (AUCs) were significantly greater with the combined approach than with either individual approach and support its favorable ability to predict ejection fraction response to cardiac resynchronization therapy. Sensitivities and specificities were 72% and 77% for the 2-site tissue Doppler method, 84% and 73% for the radial strain method, and 88% and 80% for the combined method. Blue dashed lines = individual dyssynchrony methods; red solid lines = combined method.
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Figure 4 Proportion of Patients Who Were EF Responders to Resynchronization Therapy
All patients had 2-site tissue Doppler measures of longitudinal dyssynchrony along with radial strain dyssynchrony (left), and a subgroup of 67 patients had 12-site tissue Doppler measures of longitudinal dyssynchrony along with radial strain dyssynchrony (right). A pattern of both longitudinal and radial dyssynchrony was associated with ejection fraction (EF) response, whereas a pattern of neither longitudinal nor radial dyssynchrony was associated with EF nonresponse, particularly when the 12-site tissue Doppler method excluded dyssynchrony. A heterogeneous pattern of either longitudinal or radial dyssynchrony (but not both) had an intermediate proportion of responders. *p < 0.05 versus both groups; p < 0.05 versus either group.
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