New Approach for Rotational Dyssynchrony Using Three-Dimensional Speckle Tracking Echocardiography

Left ventricular (LV) twist can be evaluated using two-dimensional speckle tracking echocardiography (2DSTE) by analyzing difference between apical and basal rotation. However, it is unable to evaluate global rotational dyssynchrony because it cannot assess mid-wall rotation. Recently developed three-dimensional STE (3DSTE) can investigate LV global rotational dyssynchrony. In this study, we investigated the role of torsion on the long-term effects of cardiac resynchronization therapy (CRT) using 3DSTE. We evaluated 43 patients by 3DSTE: 12 CRT responders, 14 CRT nonresponders, and 17 healthy normal controls. Regional torsion and rotation were assessed using 3DSTE across 16 segments during CRT-off (native conduction) and CRT-on. The following parameters were calculated: global peak twist, global peak twist (difference between CRT-on and CRT-off), and torsion delay index. The torsion delay index was considered to be the rotational energy lost by rotational dyssynchrony. Global peak twist did not show significant differences between the responders and nonresponders during CRT-off (4.0 +/- 3.4 degrees vs. 2.8 +/- 2.3 degrees, P=0.295), but it significantly improved in responders compared to nonresponders after CRT-on (5.4 +/- 3.5 degrees vs. 2.6 +/- 2.6 degrees, P=0.029). The torsion delay index during CRT-off was significantly higher in responders compared to nonresponders and normal controls (18.5 +/- 11.3 vs. 8.6 +/- 3.8 and 7.8 +/- 5.5, P=0.010 and P=0.004, respectively). The torsion delay index during CRT-off significantly correlated with the global peak twist (r=0.503, P=0.009). Improvement in LV global peak twist, which is one of the mechanisms for the long-term effects of CRT correlated with the torsion delay index during native conduction that can only be calculated by 3DSTE.