Clinical study: diagnostics and heart failure
Tissue doppler imaging predicts improved systolic performance and reversed left ventricular remodeling during long-term cardiac resynchronization therapy

https://doi.org/10.1016/S0735-1097(02)02010-7Get rights and content
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Abstract

Objectives

We sought to evaluate the long-term impact of cardiac resynchronization therapy (CRT) on left ventricular (LV) performance and remodeling using three-dimensional echocardiography and tissue Doppler imaging (TDI).

Background

Three-dimensional echocardiography and TDI allow rapid and accurate evaluation of LV volumes and performance.

Methods

Twenty-five consecutive patients with severe heart failure and bundle branch block who underwent biventricular pacemaker implantation were included. Before and after implantation of the pacemaker, three-dimensional echocardiography and TDI were performed. These examinations were repeated at outpatient visits every six months.

Results

Five patients (20%) died during one-year follow-up. In the remaining 20 patients, significant reductions in LV end-diastolic volume and LV end-systolic volume of 9.6 ± 14% and 16.5 ± 15%, respectively (p < 0.01), could be demonstrated during long-term follow-up. Accordingly, LV ejection fraction increased by 21.7 ± 18% (p < 0.01). According to a newly developed TDI technique—tissue tracking—all regional myocardial segments improved their longitudinal systolic shortening (p < 0.01). The extent of the LV base displaying delayed longitudinal contraction, as detected by TDI before pacemaker implantation, predicted long-term efficacy of CRT. The QRS duration failed to predict resynchronization efficacy.

Conclusions

Cardiac resynchronization significantly improved LV function and reversed LV remodeling during long-term follow-up. Patients likely to benefit from CRT can be identified by TDI before implantation of a biventricular pacemaker.

Abbreviations

CRT
cardiac resynchronization therapy
DLC
delayed longitudinal contraction
GSCA
global systolic contraction amplitude
LV
left ventricle/ventricular
LVEF
left ventricular ejection fraction
NYHA
New York Heart Association
RV
right ventricle/ventricular
SR
strain rate
TDI
tissue Doppler imaging
TT
tissue tracking

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