Article Text

other Versions

PDF
Tissue Doppler Velocity is Superior to Strain Imaging in Predicting Long-term Cardiovascular Events After Cardiac Resynchronization Therapy
  1. Qing Zhang (qingzhang{at}cuhk.edu.hk)
  1. The Chinese University of Hong Kong, Hong Kong
    1. RJ van Bommel
    1. Leiden University Medical Centre, Netherlands
      1. Jeffrey Wing-Hong Fung
      1. The Chinese University of Hong Kong, Hong Kong
        1. Joseph Yat-Sun Chan
        1. The Chinese University of Hong Kong, Hong Kong
          1. Gabe B Bleeker
          1. Leiden University Medical Centre, Netherlands
            1. Claudia Ypenburg
            1. Leiden University Medical Centre, Netherlands
              1. Gabriel Yip
              1. The Chinese University of Hong Kong, Hong Kong
                1. Yu-jia Liang
                1. The Chinese University of Hong Kong, Hong Kong
                  1. Martin J Schalij
                  1. Leiden University Medical Centre, Netherlands
                    1. Jeroen J Bax
                    1. Leiden University Medical Centre, Netherlands
                      1. Cheuk-Man Yu (cmyu{at}cuhk.edu.hk)
                      1. The Chinese University of Hong Kong, Hong Kong

                        Abstract

                        Objective: To examine the predictive value of systolic dyssynchrony measured by tissue Doppler velocity versus tissue Doppler strain imaging on long-term outcome after cardiac resynchronization therapy (CRT).

                        Design: Cohort study.

                        Setting: Two university hospitals.

                        Patients: Two hundred and thirty-nine patients (65±12 years, 76% males) who underwent CRT.

                        Interventions: Baseline echocardiography with tissue Doppler imaging (TDI) and clinical follow up for 37±20 months.

                        Main outcome measures: The time to peak systolic velocity during ejection phase (Ts) and the time to peak systolic strain (T∊) were assessed for dyssynchrony, i.e. the maximal delay in Ts and the maximal delay in T∊ among the 4 left ventricular basal segments. Occurrence of cardiovascular endpoints between patients with and without dyssynchrony was compared by Kaplan-Meier curves, followed by Cox regression analysis for potential predictor(s).

                        Results: There were 78 (33%) deaths, with cardiovascular causes in 64 (27%) patients, while 136 (57%) patients were hospitalized for cardiovascular events, including decompensated heart failure in 87 (36%) patients. Patients with the maximal delay in Ts ≥65ms showed a lower event rate for cardiovascular mortality (19% vs. 38%, Log-rank χ2=7.803, p=0.005) and other prognostic endpoints. In Cox regression analysis, the maximal delay in Ts (HR: 0.463, 95% CI: 0.270-0.792, p=0.005) and ischemic etiology (HR: 2.716, 95% CI: 1.505-4.901, p=0.001) were independent predictors of cardiovascular mortality. In contrast, the maximal delay in T∊≥80ms failed to predict any cardiovascular event.

                        Conclusions: Echocardiographic evidence of pre-pacing systolic dyssynchrony measured by TDI velocity, but not TDI strain, predicted lower long-term cardiovascular events after CRT.

                        Statistics from Altmetric.com

                        Request permissions

                        If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.