Evaluation of Longitudinal and Radial Two-dimensional Strain Imaging Versus Doppler Tissue Echocardiography in Predicting Long-term Response to Cardiac Resynchronization Therapy

Abstract

Cardiac resynchronization therapy (CRT) leads to hemodynamic and clinical improvement in patients with heart failure. This study compares the new technique of 2-dimensional (2D) strain imaging with Doppler tissue imaging (DTI) in the prediction of the long-term response to CRT. In all, 38 patients with heart failure (New York Heart Association II-III, QRS > 120 milliseconds, left ventricular ejection fraction < 0.35) received CRT and echocardiographic evaluation with a mean follow-up of 9.4 months. Of the patients, 47.4% were hemodynamic responders to long-term CRT. In the responder group, the maximum delay in the longitudinal and radial 2D strain in the basal segments and the maximum delay in the DTI peak systolic myocardial velocities but not DTI strain decreased. In receiver operating characteristic analysis, the baseline delay of DTI peak velocities predicts improvement after CRT, whereas baseline 2D- and DTI-strain measurements fail to predict a long-term response to CRT. Although there is a significant decrease in longitudinal and radial 2D strain-derived delays after CRT, the resulting predictive value is not superior to DTI.