Abstract

Objectives Several 2-dimensional TDI echocardiographic techniques have proven useful to identify CRT responders. Recently a 3-dimensional probe allowing simultaneous acquisition of TDI data in 3 imaging planes became available. The present study evaluated the value of tri-plane tissue Doppler imaging (TDI) to predict reverse left ventricular (LV) remodeling after cardiac resynchronization therapy (CRT).

Methods Sixty heart failure patients, scheduled for CRT, underwent tri-plane echocardiography with simultaneous TDI acquisition before and 6 months after implantation. From the tri-plane dataset a 3-dimensional left ventricular (LV) volume was generated and LV volumes and ejection fraction were calculated. Intraventricular dyssynchrony was quantitatively analyzed by evaluating time from onset QRS to peak myocardial systolic velocity in 12 LV segments from the tri-plane dataset and calculation of the standard deviation (Ts-SD-12). Clinical response was defined as an improvement of at least 1 New York Heart Association class. Reverse LV remodeling was defined as at least 15% decrease of LV end-systolic volume at 6 months follow-up.

Results Responders to CRT had significantly more LV dyssynchrony at baseline than non-responders; Ts-SD-12: 42(14) versus 22(12) (P<0.0001). A cut-off value of 33 for baseline Ts-SD-12, acquired from the tri-plane TDI dataset, yielded a sensitivity of 89% with a specificity of 82% to predict clinical response to CRT; sensitivity and specificity to predict reverse LV remodeling were 90% and 83%.

Conclusion Tri-plane TDI echocardiography predicts clinical response and reverse LV remodeling 6 months after CRT implantation.