Tissue synchronization imaging accurately measures left ventricular dyssynchrony and predicts response to cardiac resynchronization therapy

Nico Van de Veire ^1*, Gabe Bleeker ², Johan De Sutter ¹, Claudia Ypenburg ², Eduard Holman ², Ernst van der Wall ², Martin Schalij ² and Jeroen J Bax ²

¹ Ghent University, Belgium
² Leiden University Medical Center, Netherlands

^* To whom correspondence should be addressed. E-mail: nico.vandeveire{at}ugent.be.

Accepted 28 November 2006

Abstract

Objectives Tissue synchronization imaging (TSI) is a new technique to assess left ventricular (LV) dyssynchrony. The value of TSI to assess LV dyssynchrony automatically was compared directly to manual assessment of LV dyssynchrony from color-coded tissue Doppler imaging (TDI). In addition, the value of TSI to predict response to cardiac resynchronization therapy (CRT) was evaluated.

Methods Sixty symptomatic heart failure patients 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 color-coded TDI and automatically using TSI. LV volumes and LVEF were assessed from 2D echocardiography. Clinical responders had to exhibit an improvement in NYHA functional class by >=1 score and an improvement by >=25% in 6-min walking distance after 6 months. Reverse LV remodeling was defined as a reduction of >=15% LV end-systolic volume.

Results There was an excellent correlation between LV dyssynchrony measured manually and automatically derived by TSI (r=0.95, p<0.0001). Thirty-four patients showed clinical response after 6 months of CRT and thirty-two patients showed reverse remodeling. Baseline characteristics were comparable between responders and non-responders, except for more extensive LV dyssynchrony in the responders: 78(26) ms vs 29(29) ms (p<0.0001) as assessed manually, and 79(29) ms vs 28(27) ms (p<0.0001) as assessed with TSI. Using a cutoff value of 65 ms to define extensive LV dyssynchrony, TSI had sensitivity of 81% with a specificity of 89% to predict reverse LV remodeling.

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

Keywords: cardiac resynchronization therapy, dyssynchrony, tissue Doppler Imaging, tissue synchronization imaging

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Zhang, Q, van Bommel, R J, Fung, J W-H, Chan, J Y-S, Bleeker, G B, Ypenburg, C, Yip, G, Liang, Y-j, Schalij, M J, Bax, J J, Yu, C-M (2009). Tissue Doppler velocity is superior to strain imaging in predicting long-term cardiovascular events after cardiac resynchronisation therapy. Heart 95: 1085-1090 [Abstract] [Full Text]  
• Hawkins, N. M., Petrie, M. C., Burgess, M. I., McMurray, J. J.V. (2009). Selecting patients for cardiac resynchronization therapy: the fallacy of echocardiographic dyssynchrony.. J Am Coll Cardiol 53: 1944-1959 [Abstract] [Full Text]  
• Voigt, J.-U., Schneider, T.-M., Korder, S., Szulik, M., Gurel, E., Daniel, W. G., Rademakers, F., Flachskampf, F. A. (2009). Apical transverse motion as surrogate parameter to determine regional left ventricular function inhomogeneities: a new, integrative approach to left ventricular asynchrony assessment. Eur Heart J 30: 959-968 [Abstract] [Full Text]  
• Hayashi, S. Y., Seeberger, A., Lind, B., Nowak, J., do Nascimento, M. M., Lindholm, B., Brodin, L.-A. (2008). A single session of haemodialysis improves left ventricular synchronicity in patients with end-stage renal disease: a pilot tissue synchronization imaging study. Nephrol Dial Transplant 23: 3622-3628 [Abstract] [Full Text]  
• Marsan, N. A., Breithardt, O. A., Delgado, V., Bertini, M., Tops, L. F. (2008). Predicting response to CRT. The value of two- and three-dimensional echocardiography. Europace 10: iii73-iii79 [Abstract] [Full Text]  
• Chung, R, Sutton, R, Henein, M Y (2008). Beyond dyssynchrony in cardiac resynchronisation therapy. Heart 94: 991-994 [Abstract] [Full Text]  
• Van de Veire, N R, De Sutter, J, Bax, J J, Roelandt, J R T C (2008). Technological advances in tissue Doppler imaging echocardiography. Heart 94: 1065-1074 [Abstract] [Full Text]  
• Anderson, L. J., Miyazaki, C., Sutherland, G. R., Oh, J. K. (2008). Patient Selection and Echocardiographic Assessment of Dyssynchrony in Cardiac Resynchronization Therapy. Circulation 117: 2009-2023 [Full Text]  
• De Boeck, B. W.L., Meine, M., Leenders, G. E., Teske, A. J., van Wessel, H., Kirkels, J. H., Prinzen, F. W., Doevendans, P. A., Cramer, M. J. (2008). Practical and conceptual limitations of tissue Doppler imaging to predict reverse remodelling in cardiac resynchronisation therapy. Eur J Heart Fail 10: 281-290 [Abstract] [Full Text]