Background Definition of the optimal left ventricular (LV) lead position in cardiac resynchronization therapy (CRT) is desirable. This study used novel myocardial deformation imaging to define the optimal LV lead position in CRT and assessed the effectiveness of CRT depending on the LV lead position.
Methods Myocardial deformation imaging based on tracking of acoustic tissue pixels in 2D echocardiographic images (EchoPAC, GE Ultrasound) was performed in 47 heart failure patients at baseline and during CRT. In a 36 segment LV model the segment with latest peak systolic circumferential strain prior to CRT was determined. The segment with maximal temporal difference in peak systolic circumferential strain on CRT compared to prior to CRT was assumed to be the LV lead position. Optimal LV lead position was defined as concurrence or immediate neighbouring of the segment with latest contraction prior to CRT and those with assumed LV lead location.
Results 25 patients had optimal and 22 non-optimal LV lead position. Before CRT, LV ejection fraction (EF) and peak oxygen consumption (VO2max) were similar between optimal and non-optimal LV lead position patients (EF 31.4±6.1 vs. 30.3±6.5% and VO2max 14.5±1.8 vs. 14.2±2.1 ml/min/kg, respectively). At 3 months on CRT, EF increased by 9±2 vs 5±3% and VO2max by 2.1±0.9 vs. 1.0±0.6 ml/min/kg in the optimal vs non-optimal LV lead position groups, respectively (both p<0.001).
Conclusions Concordance of LV lead site and location of latest systolic contraction prior to CRT results in greater improvement in EF and cardiopulmonary workload than non-optimal LV lead position.
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