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Cardiac imaging and non-invasive testing
Measurement of left ventricular dyssynchrony in patients with ischaemic cardiomyopathy: a comparison of real-time three-dimensional and tissue Doppler echocardiography
  1. Malcolm I Burgess,
  2. Carly Jenkins,
  3. Jonathan Chan,
  4. Thomas H Marwick
  1. University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  1. Professor T H Marwick, University of Queensland Department of Medicine, Princess Alexandra Hospital, Ipswich Road, Brisbane, QLD 4120, Australia; t.marwick{at}uq.edu.au

Abstract

Background: Real-time three-dimensional echocardiography (RT3DE) is an alternative modality to tissue Doppler imaging (TDI) for assessment of intraventricular dyssynchrony but its role is yet to be defined.

Objectives: To (1) compare RT3DE and TDI for assessment of intraventricular dyssynchrony; (2) determine whether the two techniques agreed regarding the magnitude of dyssynchrony and identification of the site of maximal mechanical delay; and (3) investigate the reason for disagreement.

Patients: 100 patients with ischaemic cardiomyopathy.

Setting: Tertiary referral cardiac unit.

Main outcome measures: Dispersion in time interval from QRS onset to peak sustained systolic tissue velocity by TDI (SD-TTV) and to minimal systolic volume by RT3DE (SD-T3D) between 12 ventricular segments.

Results: RT3DE image quality was adequate for measurement of SD-T3D in 77 (77%) patients. In the whole population, SD-TTV was 40 (20) ms and SD-T3D was 8.3% (3.4%). RT3DE identified a smaller proportion of patients as having significant dyssynchrony than TDI (49 (64%) patients vs 32 (42%) patients; p<0.01). The correlation between SD-TTV and SD-T3D was poor (r = 0.11, p = NS). There was concordance between TDI and RT3DE in identifying the site of maximal mechanical delay in 12 (16%) patients. Validating the two techniques with anatomical M-mode (AMM) as a parameter of radial timing revealed better agreement with RT3DE than with TDI (χ2 = 11.8, p = 0.001).

Conclusion: In patients with ischaemic cardiomyopathy, TDI and RT3DE show poor agreement for evaluating the magnitude of intraventricular dyssynchrony and the site of maximal mechanical delay. This may partly relate to their respective assessment of longitudinal versus radial timing.

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Footnotes

  • Funding: MIB is supported by a University of Queensland Postdoctoral Research Fellowship.

  • Competing interests: None.

  • Ethical approval: Use of the data for analysis was approved by the hospital’s human research ethics committee.

  • Abbreviations:
    AMM
    anatomical M-mode
    RT3DE
    real-time three-dimensional echocardiography
    SD-TTV
    standard deviation in time interval from QRS onset to peak sustained systolic tissue velocity across all segments
    SD-T3D
    standard deviation in time interval from QRS onset to minimal systolic volume
    TAMM
    time interval from QRS onset to peak myocardial incursion in systole
    TDI
    tissue Doppler imaging
    TTV
    time interval from QRS onset to peak sustained systolic tissue velocity
    T3D
    time interval from QRS onset to minimal systolic volume

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