Objective To compare real-time three-dimensional echocardiography (RT3DE) and (tissue Doppler imaging) TDI for assessment of intra-ventricular dyssynchrony. To determine if the two techniques agreed regarding the magnitude of dyssynchrony and identification of the site of maximal mechanical delay and investigate the reason for disagreement.
Background RT3DE is an alternative modality to TDI for assessment of intra-ventricular dyssynchrony but its role has yet to be defined.
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 twelve 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) msec and SD-T3D was 8.3 (3.4)%. RT3DE identified a smaller proportion of patients as having significant dyssynchrony than TDI (49 [64%] patients compared to 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 anatomic M-mode as a parameter of radial timing revealed better agreement with RT3DE than TDI (X2=11.8, p=0.001).
Conclusion In patients with ischaemic cardiomyopathy TDI and RT3DE show poor agreement for evaluating magnitude of intra-ventricular 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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