Novel speckle-tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy

被引:732
作者
Suffoletto, MS [1 ]
Dohi, K [1 ]
Cannesson, M [1 ]
Saba, S [1 ]
Gorcsan, J [1 ]
机构
[1] Univ Pittsburgh, Cardiovasc Inst, Pittsburgh, PA 15213 USA
关键词
echocardiography; heart failure; pacemakers;
D O I
10.1161/CIRCULATIONAHA.105.571455
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background - Mechanical dyssynchrony is a potential means to predict response to cardiac resynchronization therapy (CRT). We hypothesized that novel echocardiographic image speckle tracking can quantify dyssynchrony and predict response to CRT. Methods and Results - Seventy-four subjects were studied: 64 heart failure patients undergoing CRT (aged 64 +/- 12 years, ejection fraction 26 +/- 6%, QRS duration 157 +/- 28 ms) and 10 normal controls. Speckle tracking applied to routine midventricular short-axis images calculated radial strain from multiple circumferential points averaged to 6 standard segments. Dyssynchrony from timing of speckle-tracking peak radial strain was correlated with tissue Doppler measures in 47 subjects (r = 0.94, P < 0.001; 95% CI 0.90 to 0.96). The ability of baseline speckle-tracking radial dyssynchrony ( time difference in peak septal wall - to - posterior wall strain >= 130 ms) to predict response to CRT was then tested. It predicted an immediate increase in stroke volume in 48 patients studied the day after CRT with 91% sensitivity and 75% specificity. In 50 patients with long-term follow-up 8 +/- 5 months after CRT, baseline speckle-tracking radial dyssynchrony predicted a significant increase in ejection fraction with 89% sensitivity and 83% specificity. Patients in whom left ventricular lead position was concordant with the site of latest mechanical activation by speckle-tracking radial strain had an increase in ejection fraction from baseline to a greater degree (10 +/- 5%) than patients with discordant lead position (6 +/- 5%; P < 0.05). Conclusions - Speckle-tracking radial strain can quantify dyssynchrony and predict immediate and long-term response to CRT and has potential for clinical application.
引用
收藏
页码:960 / 968
页数:9
相关论文
共 38 条
[1]   Cardiac resynchronization in chronic heart failure [J].
Abraham, WT ;
Fisher, WG ;
Smith, AL ;
Delurgio, DB ;
Leon, AR ;
Loh, E ;
Kocovic, DZ ;
Packer, M ;
Clavell, AL ;
Hayes, DL ;
Ellestad, M ;
Messenger, J ;
Trupp, RJ ;
Underwood, J ;
Pickering, F ;
Truex, C ;
McAtee, P .
NEW ENGLAND JOURNAL OF MEDICINE, 2002, 346 (24) :1845-1853
[2]   Doppler myocardial Imaging to evaluate the effectiveness of pacing sites in patients receiving biventricular pacing [J].
Ansalone, G ;
Giannantoni, P ;
Ricci, R ;
Trambaiolo, P ;
Fedele, F ;
Santini, M .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 39 (03) :489-499
[3]   Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy [J].
Bax, JJ ;
Bleeker, GB ;
Marwick, TH ;
Molhoek, SG ;
Boersma, E ;
Steendijk, P ;
van der Wall, EE ;
Schalij, MJ .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2004, 44 (09) :1834-1840
[4]   STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT [J].
BLAND, JM ;
ALTMAN, DG .
LANCET, 1986, 1 (8476) :307-310
[5]   Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure [J].
Bristow, MR ;
Saxon, LA ;
Boehmer, J ;
Krueger, S ;
Kass, DA ;
De Marco, T ;
Carson, P ;
DiCarlo, L ;
DeMets, D ;
White, BG ;
DeVries, DW ;
Feldman, AM .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 350 (21) :2140-2150
[6]   Effect of resynchronization therapy stimulation site on the systolic function of heart failure patients [J].
Butter, C ;
Auricchio, A ;
Stellbrink, C ;
Fleck, E ;
Ding, J ;
Yu, YH ;
Huvelle, E ;
Spinelli, J .
CIRCULATION, 2001, 104 (25) :3026-3029
[7]   The effect of cardiac resynchronization on morbidity and mortality in heart failure [J].
Cleland, JGF ;
Daubert, J ;
Erdmann, E ;
Freemantle, N ;
Gras, D ;
Kappenberger, L ;
Tavazzi, L ;
Cleland, JGF ;
Daubert, JC ;
Erdmann, E ;
Gras, D ;
Kappenberger, L ;
Klein, W ;
Tavazzi, L ;
Poole-Wilson, PA ;
Rydén, L ;
Wedel, H ;
Wellens, HJJ ;
Uretsky, B ;
Thygesen, K ;
Böcker, D ;
Marijianowski, MMH ;
Freemantle, N ;
Calvert, MJ ;
Christ, G ;
Fruhwald, F ;
Hofmann, R ;
Krypta, A ;
Leisch, F ;
Pacher, R ;
Rauscha, F ;
Tavernier, R ;
Thomsen, PEB ;
Boesgaard, S ;
Eiskjær, H ;
Esperen, GT ;
Haarbo, J ;
Hagemann, A ;
Korup, E ;
Moller, M ;
Mortensen, P ;
Sogaard, P ;
Vesterlund, T ;
Huikuri, H ;
Niemelä, KI ;
Toivonen, L ;
Bauer, F ;
Cohen-Solal, A ;
Crocq, C ;
Djiane, P .
NEW ENGLAND JOURNAL OF MEDICINE, 2005, 352 (15) :1539-1549
[8]   Two-dimensional ultrasonic strain rate measurement of the human heart in vivo [J].
D'hooge, J ;
Konofagou, E ;
Jamal, F ;
Heimdal, A ;
Barrios, L ;
Bijnens, B ;
Thoen, J ;
Van de Werf, F ;
Sutherland, G ;
Suetens, P .
IEEE TRANSACTIONS ON ULTRASONICS FERROELECTRICS AND FREQUENCY CONTROL, 2002, 49 (02) :281-286
[9]   Utility of echocardiographic radial strain imaging to quantify left ventricular dyssynchrony and predict acute response to cardiac resynchronization therapy [J].
Dohi, K ;
Suffoletto, MS ;
Schwartzman, D ;
Ganz, L ;
Pinsky, MR ;
Gorcsan, J .
AMERICAN JOURNAL OF CARDIOLOGY, 2005, 96 (01) :112-116
[10]   Is the left ventricular lateral wall the best lead implantation site for cardiac resynchronization therapy? [J].
Gasparini, M ;
Mantica, M ;
Galimberti, P ;
Bocciolone, M ;
Genovese, L ;
Mangiavacchi, M ;
La Marchesina, U ;
Faletra, F ;
Klersy, C ;
Coates, R ;
Gronda, E .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2003, 26 (01) :162-168