Original articleEvaluation of ventricular synchrony using novel Doppler echocardiographic indices in patients with heart failure receiving cardiac resynchronization therapy
Section snippets
Patients
A total of 34 consecutive patients with dilated ischemic (20), primary (13), or valvular (1) cardiomyopathy (61 ± 15 years; 25 men) were enrolled between March 2001 and March 2002. Inclusion criteria were symptomatic functional class New York Heart Association class II to IV; QRS duration ≥ 130 milliseconds; LV ejection fraction ≤ 35%; LV end-diastolic diameter ≥ 55 mm; and a stable pharmacologic regimen of diuretics, angiotensin-converting enzyme inhibitors, and β-blockers (unless otherwise
Patients characteristics
Initial average QRS complex duration was 184 ± 20 milliseconds. A LBBB pattern was present in all but one patient, who had a right bundle branch block pattern. The LV pacing lead was placed in the posterior-lateral or lateral position in 24 patients (70.5%) and in a posterior or anterior position for 10 (29.5%). The RV pacing lead was positioned in the apex in 28 patients, on the septal wall in 5 patients, and in the RV outflow tract in 1 patient. The intrinsic sinus rate was 64 ± 10 bpm, and
Discussion
The major finding of this study is that LV or BiV pacing at an optimal atrio-ventricular delay could significantly and consistently improve LV systolic function of patients with moderate to severe chronic heart failure and a LBBB. The therapy was associated with improved contraction synchrony between opposite LV walls. In this group of patients, LV pacing produced comparable effects with BiV pacing with respect to LV function.
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Cited by (43)
Optimization of pacing after cardiopulmonary bypass
2012, Journal of Cardiothoracic and Vascular AnesthesiaLeft Ventricular Strain Patterns in Dilated Cardiomyopathy Predict Response to Cardiac Resynchronization Therapy: Timing Is Not Everything
2009, Journal of the American Society of EchocardiographyCitation Excerpt :Peak strain is a considerably later event (end-systolic or even later in delayed segments) than peak systolic velocity. As such, tissue Doppler echocardiographic methods used to detect dyssynchrony6,10-19,30-37 are unable to fully describe mechanical dyssynchrony, which is the actual target of CRT. As was recently shown,38 we too have found that the prevalence of Doppler assessed baseline dyssynchrony is similar in responders and nonresponders.
Feasibility of a New Tissue Doppler Based Method for Comprehensive Evaluation of Left-Ventricular Intra-Ventricular Mechanical Dyssynchrony in Children With Dilated Cardiomyopathy
2008, Journal of the American Society of EchocardiographyCitation Excerpt :Multiple echocardiographic methods and indices have been proposed as indicators of mechanical dyssynchrony. These have included, among others, aortic-to-pulmonary delay by Doppler flow to assess for interventricular dyssynchrony18; peak septal-to-posterior wall motion delay by M-mode echocardiography19; the delay between onset or peak tissue velocities or between peak strain or strain rate obtained by Doppler tissue imaging among various LV segments20-23; other tissue Doppler–based methods using tissue tracking,24 tissue displacement,25 or tissue synchronization imaging26; as well as 3-dimensional echocardiographic techniques.27 Among these, the use of Doppler tissue imaging is prevalent because it is relatively easy to acquire, provides robust signals, and may be preferential to other methods.14
Echocardiography for Cardiac Resynchronization Therapy: Recommendations for Performance and Reporting-A Report from the American Society of Echocardiography Dyssynchrony Writing Group Endorsed by the Heart Rhythm Society
2008, Journal of the American Society of EchocardiographyCitation Excerpt :The same septal-to-posterior wall-motion delay greater than or equal to 130 milliseconds is considered to be significant dyssynchrony, although this method is affected by similar limitations with routine M-mode as described above. The largest body of literature to quantify dyssynchrony is represented by the assessment of longitudinal LV shortening velocities using TD from the apical windows.14-16,37-49 This is the principal method currently in clinical use, although it has limitations discussed subsequently.
Two-dimensional strain imaging: A new echocardiographic advance with research and clinical applications
2008, International Journal of CardiologyCitation Excerpt :The quantification of strain measurements derived from TDI has been extensively validated [4,10,13,14]. Tissue Doppler-derived strain has over the last ten years been utilised in a great many clinical situations including the assessment of ischaemia and stress echocardiography [15–20], in the evaluation of dyssynchrony [21–25] and the assessment of function in relation to valve abnormalities [26]. TDI, like all Doppler-derived measurements, is dependent upon the angle of insonation [27].
Evaluation of left ventricular mechanical dyssynchrony as determined by phase analysis of ECG-gated SPECT myocardial perfusion imaging in patients with left ventricular dysfunction and conduction disturbances
2007, Journal of Nuclear CardiologyCitation Excerpt :These efforts have primarily focused on the use of advanced echocardiographic techniques to determine left ventricular mechanical dyssynchrony. These include M-mode echocardiography,26-28 pulsed-wave tissue Doppler imaging,29-32 color-coded tissue Doppler imaging,33-40 strain and strain rate imaging,41-44 tissue synchronization imaging,45,46 and real-time 3-dimensional echocardiography.47 Although some techniques have been shown to predict clinical, hemodynamic, or echocardiographic response to CRT in small series of patients, none has been fully validated in large prospective trials.