Abstract
BackgroundAlmost all attempts to improve patient selection for cardiac resynchronization therapy (CRT) using echo-derived indices have failed so far. We sought to assess: the performance of homemade software for the automatic quantification of integral 3D regional longitudinal strain curves exploring left ventricular (LV) mechanics and the potential value of this tool to predict CRT response.MethodsForty-eight heart failure patients in sinus rhythm, referred for CRT-implantation (mean age: 65 years; LV-ejection fraction: 26%; QRS-duration: 160 milliseconds) were prospectively explored. Thirty-four patients (71%) had positive responses, defined as an LV end-systolic volume decrease ≥15% at 6-months. 3D–longitudinal strain curves were exported for analysis using custom-made algorithms. The integrals of the longitudinal strain signals (IL,peak) were automatically measured and calculated for all 17 LV-segments.ResultsThe standard deviation of longitudinal strain peak (SDIL,peak) for all 17 LV-segments was greater in CRT responders than non-responders (1.18% s−1 [0.96; 1.35] versus 0.83% s−1 [0.55; 0.99], p = 0.007). The optimal cut-off value of SDIL,peak to predict response was 1.037%.s−1. In the 18-patients without septal flash, SDIL,peak was significantly higher in the CRT-responders.ConclusionsThis new automatic software for analyzing 3D longitudinal strain curves is avoiding previous limitations of imaging techniques for assessing dyssynchrony and then its value will have to be tested in a large group of patients.
Highlights
Almost all attempts to improve patient selection for cardiac resynchronization therapy (CRT) using echo-derived indices have failed so far
Ischemic etiology was defined by a history of previous myocardial infarction or prior coronary revascularization or if a > 75% stenosis was observed in ≥1 of the major epicardial coronary arteries [15]
A total of 48 heart-failure patients referred for CRT device implantation were included in this study. 15 patients (31%) had ischemic cardiomyopathy
Summary
Almost all attempts to improve patient selection for cardiac resynchronization therapy (CRT) using echo-derived indices have failed so far. We sought to assess: the performance of homemade software for the automatic quantification of integral 3D regional longitudinal strain curves exploring left ventricular (LV) mechanics and the potential value of this tool to predict CRT response. 3D speckle-tracking echocardiography (STE) has been proposed as an alternative and potentially more accurate method for quantifying LVMD and for identifying patients suitable for CRT [11,12,13]. These different approaches are typically based on analyzing differences in either myocardial velocity timing, by means of tissue Doppler imaging (TDI), or in Fournet et al Cardiovascular Ultrasound (2017) 15:15 myocardial deformation using 2D/3D STE. To describe the complexity of LV mechanics, we believe it is essential to perform a combined assessment of LV dyssynchrony and LV regional contractility using STE, by means of longitudinal strain analysis
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