Abstract
BackgroundEstablished methods to determine asynchrony suffer from high intra- and interobserver variability and failed to improve patient selection for cardiac resynchronization therapy (CRT). Thus, there is a need for easy and robust approaches to reliably assess cardiac asynchrony.Methods and ResultsWe performed echocardiography in 100 healthy subjects and 33 patients with left bundle branch block (LBBB). To detect intraventricular asynchrony, we combined two established methods, i.e., tissue synchronization imaging (TSI) and tissue Doppler imaging (TDI). The time intervals from the onset of aortic valve opening (AVO) to the peak systolic velocity (S') were measured separately in six basal segments in the apical four-, two-, and three-chamber view. Color-coded TSI served as an intrinsic plausibility control and helped to identify the correct S' measuring point in the TDI curves. Next, we identified the segment with the shortest AVO-S' interval. Since this segment most likely represents vital and intact myocardium it served as a reference for other segments. Segments were considered asynchronous when the delay between the segment in question and the reference segment was above the upper limit of normal delays derived from the control population. Intra- and interobserver variability were 7.0% and 7.7%, respectively.ConclusionOur results suggest that combination of TDI and TSI with intrinsic plausibility control improves intra- and interobserver variability and allows easy and reliable assessment of cardiac asynchrony.
Highlights
Established methods to determine asynchrony suffer from high intra- and interobserver variability and failed to improve patient selection for cardiac resynchronization therapy (CRT)
Matching tissue Doppler imaging (TDI) and tissue synchronization imaging (TSI) served as an intrinsic plausibility control and was used to confirm correct determination of aortic valve opening (AVO)-S' intervals by TDI
Except for the anterior wall, asynchrony was significantly more prevalent in all other segments in left bundle branch block (LBBB) patients compared to healthy controls. 82% of LBBB patients had more than one asynchronous segment
Summary
Established methods to determine asynchrony suffer from high intra- and interobserver variability and failed to improve patient selection for cardiac resynchronization therapy (CRT). In 85 patients, this parameter predicted reverse LV remodeling after cardiac resynchronization therapy (CRT) with a sensitivity and specificity of 92% [3]. Another promising approach is based on the standard deviations of the times from QRS to peak systolic velocity in twelve LV segments (Ts-SD-12). Suggest that placing the left ventricular lead close to the most delayed segment might improve response to CRT [8,9,10,11,12,13] As this requires a reliable identification of asynchronous segments, improvement of echocardiographic parameters for cardiac asynchrony remains clinically important
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