Tissue Doppler imaging predicts improved systolic performance and reversed left ventricular remodeling during long-term cardiac resynchronization therapy

J Am Coll Cardiol. 2002 Aug 21;40(4):723-30. doi: 10.1016/s0735-1097(02)02010-7.


Objectives: We sought to evaluate the long-term impact of cardiac resynchronization therapy (CRT) on left ventricular (LV) performance and remodeling using three-dimensional echocardiography and tissue Doppler imaging (TDI).

Background: Three-dimensional echocardiography and TDI allow rapid and accurate evaluation of LV volumes and performance.

Methods: Twenty-five consecutive patients with severe heart failure and bundle branch block who underwent biventricular pacemaker implantation were included. Before and after implantation of the pacemaker, three-dimensional echocardiography and TDI were performed. These examinations were repeated at outpatient visits every six months.

Results: Five patients (20%) died during one-year follow-up. In the remaining 20 patients, significant reductions in LV end-diastolic volume and LV end-systolic volume of 9.6 +/- 14% and 16.5 +/- 15%, respectively (p < 0.01), could be demonstrated during long-term follow-up. Accordingly, LV ejection fraction increased by 21.7 +/- 18% (p < 0.01). According to a newly developed TDI technique-tissue tracking-all regional myocardial segments improved their longitudinal systolic shortening (p < 0.01). The extent of the LV base displaying delayed longitudinal contraction, as detected by TDI before pacemaker implantation, predicted long-term efficacy of CRT. The QRS duration failed to predict resynchronization efficacy.

Conclusions: Cardiac resynchronization significantly improved LV function and reversed LV remodeling during long-term follow-up. Patients likely to benefit from CRT can be identified by TDI before implantation of a biventricular pacemaker.

Publication types

  • Evaluation Study

MeSH terms

  • Bundle-Branch Block / diagnostic imaging
  • Bundle-Branch Block / physiopathology
  • Bundle-Branch Block / therapy*
  • Cardiac Pacing, Artificial / methods*
  • Echocardiography, Doppler, Color
  • Echocardiography, Three-Dimensional
  • Heart Failure / diagnostic imaging
  • Heart Failure / physiopathology
  • Heart Failure / therapy*
  • Humans
  • Prognosis
  • Systole / physiology*
  • Ventricular Remodeling*