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Tissue synchronisation imaging accurately measures left ventricular dyssynchrony and predicts response to cardiac resynchronisation therapy
  1. Nico R Van de Veire1,
  2. Gabe B Bleeker2,
  3. Johan De Sutter1,
  4. Claudia Ypenburg1,
  5. Eduard R Holman1,
  6. Ernst E van der Wal1,
  7. Martin J Schalij1,
  8. Jeroen J Bax1
  1. 1Department of Cardiology, Ghent University, Gent, Belgium
  2. 2Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to:
    Dr N R Van de Veire
    Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; nico.vandeveire{at}


Background: Tissue synchronisation imaging (TSI) is a new technique to assess left ventricular (LV) dyssynchrony.

Objectives: The value of using TSI to automatically assess LV dyssynchrony compared with manual assessment of LV dyssynchrony from colour-coded tissue Doppler imaging (TDI), and to evaluate the value of TSI to predict response to cardiac resynchronisation therapy (CRT).

Methods: 60 symptomatic patients with heart failure with depressed LV ejection fraction (LVEF) and QRS >120 ms were evaluated clinically and echocardiographically at baseline and after 6 months of CRT. LV dyssynchrony was measured manually using velocity tracings from the colour-coded TDI and automatically using TSI. LV volumes and LVEF were assessed from two-dimensional echocardiography. Clinical responders had to exhibit an improvement in New York Heart Association functional class by ⩾1 score and an improvement by ⩾25% in 6 min walking distance after 6 months. Reverse LV remodelling was defined as a reduction of ⩾15% LV end-systolic volume.

Results: An excellent correlation was observed between LV dyssynchrony measured manually and automatically derived by TSI (r = 0.95, p<0.001). 34 patients showed clinical response after 6 months of CRT and 32 patients showed reverse remodelling. Baseline characteristics were comparable between responders and non-responders, except for more extensive LV dyssynchrony in the responders: 78 (26) vs 29 (29) ms (p<0.001) as assessed manually, and 79 (29) vs 28 (27) ms (p<0.001) as assessed with TSI. Using a cut-off value of 65 ms to define extensive LV dyssynchrony, TSI had a sensitivity of 81% with a specificity of 89% to predict reverse LV remodelling.

Conclusion: TSI allows automatic and reliable assessment of LV dyssynchrony and predicts reverse LV remodelling after CRT.

  • CRT, cardiac resynchronisation therapy
  • LV, left ventricular
  • LVEF, left ventricular ejection fraction
  • NYHA, New York Heart Association
  • TDI, tissue Doppler imaging
  • TSI, tissue synchronisation imaging
  • Ts, systolic velocity

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  • Published Online First 16 February 2007

  • NRVdV is a Research Assistant and JDS a Senior Clinical Investigator of the Fund for Scientific Research—Flanders (Belgium; FWO-Vlaanderen).

  • Competing interests: None declared.

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  • Correction
    BMJ Publishing Group Ltd and British Cardiovascular Society