CARDIAC IMAGING AND NON-INVASIVE TESTING

Tissue synchronisation imaging accurately measures left ventricular dyssynchrony and predicts response to cardiac resynchronisation therapy

Nico R Van de Veire¹, Gabe B Bleeker², Johan De Sutter¹, Claudia Ypenburg¹, Eduard R Holman¹, Ernst E van der Wal¹, Martin J Schalij¹, Jeroen J Bax¹

¹ Department of Cardiology, Ghent University, Gent, Belgium
² Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

Correspondence to:
Dr N R Van de Veire
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; nico.vandeveire{at}ugent.be

Background: Tissue synchronisation imaging (TSI) is a new technique to assess left ventricular (LV) dyssynchrony.

Objectives: The value of using TSI to automatically assess LV dyssynchrony compared with manual assessment of LV dyssynchrony from colour-coded tissue Doppler imaging (TDI), and to evaluate the value of TSI to predict response to cardiac resynchronisation therapy (CRT).

Methods: 60 symptomatic patients with heart failure with depressed LV ejection fraction (LVEF) and QRS >120 ms were evaluated clinically and echocardiographically at baseline and after 6 months of CRT. LV dyssynchrony was measured manually using velocity tracings from the colour-coded TDI and automatically using TSI. LV volumes and LVEF were assessed from two-dimensional echocardiography. Clinical responders had to exhibit an improvement in New York Heart Association functional class by 1 score and an improvement by 25% in 6 min walking distance after 6 months. Reverse LV remodelling was defined as a reduction of 15% LV end-systolic volume.

Results: An excellent correlation was observed between LV dyssynchrony measured manually and automatically derived by TSI (r = 0.95, p<0.001). 34 patients showed clinical response after 6 months of CRT and 32 patients showed reverse remodelling. Baseline characteristics were comparable between responders and non-responders, except for more extensive LV dyssynchrony in the responders: 78 (26) vs 29 (29) ms (p<0.001) as assessed manually, and 79 (29) vs 28 (27) ms (p<0.001) as assessed with TSI. Using a cut-off value of 65 ms to define extensive LV dyssynchrony, TSI had a sensitivity of 81% with a specificity of 89% to predict reverse LV remodelling.

Conclusion: TSI allows automatic and reliable assessment of LV dyssynchrony and predicts reverse LV remodelling after CRT.

Abbreviations: CRT, cardiac resynchronisation therapy; LV, left ventricular; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association; TDI, tissue Doppler imaging; TSI, tissue synchronisation imaging; Ts, systolic velocity

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