Combined longitudinal and radial dyssynchrony predicts ventricular response after resynchronization therapy

J Am Coll Cardiol. 2007 Oct 9;50(15):1476-83. doi: 10.1016/j.jacc.2007.06.043. Epub 2007 Sep 24.


Objectives: The purpose of this study was to test the hypothesis that a combined echocardiographic assessment of longitudinal dyssynchrony by tissue Doppler imaging (TDI) and radial dyssynchrony by speckle-tracking strain may predict left ventricular (LV) functional response to cardiac resynchronization therapy (CRT).

Background: Mechanical LV dyssynchrony is associated with response to CRT; however, complex patterns may exist.

Methods: We studied 190 heart failure patients (ejection fraction [EF] 23 +/- 6%, QRS duration 168 +/- 27 ms) before and after CRT. Longitudinal dyssynchrony was assessed by color TDI for time to peak velocity (2 sites in all and 12 sites in a subgroup of 67). Radial dyssynchrony was assessed by speckle-tracking radial strain. The LV response was defined as > or =15% increase in EF.

Results: One hundred seventy-six patients (93%) had technically sufficient baseline and follow-up data available. Overall, 34% were EF nonresponders at 6 +/- 3 months after CRT. When both longitudinal dyssynchrony by 2-site TDI (> or =60 ms) and radial dyssynchrony (> or =130 ms) were positive, 95% of patients had an EF response; when both were negative, 21% had an EF response (p < 0.001 vs. both positive). The EF response rate was lowest (10%) when dyssynchrony was negative using 12-site TDI and radial strain (p < 0.001 vs. both positive). When either longitudinal or radial dyssynchrony was positive (but not both), 59% had an EF response. Combined longitudinal and radial dyssynchrony predicted EF response with 88% sensitivity and 80% specificity, which was significantly better than either technique alone (p < 0.0001).

Conclusions: Combined patterns of longitudinal and radial dyssynchrony can be predictive of LV functional response after CRT.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Cardiac Pacing, Artificial*
  • Echocardiography, Doppler / methods*
  • Electrophysiologic Techniques, Cardiac
  • Female
  • Heart Failure / physiopathology*
  • Heart Failure / therapy*
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • ROC Curve
  • Recovery of Function
  • Sensitivity and Specificity
  • Stroke Volume
  • Treatment Outcome
  • Ventricular Function, Left*
  • Ventricular Remodeling