Guiding and optimization of resynchronization therapy with dynamic three-dimensional echocardiography and segmental volume--time curves: a feasibility study.
OBJECTIVE
To assess a new approach for guiding and hemodynamic optimization of resynchronization therapy, using three-dimensional (3D) transthoracic echocardiography.


BACKGROUND
Resynchronization therapy for heart failure provides the greatest hemodynamic benefit when applied to the most delayed left ventricular (LV) site. Currently, the ideal LV pacing site is selected according to acute invasive hemodynamic assessment and/or tissue Doppler imaging.


METHODS
A total of 16 patients with advanced heart failure and an implanted biventricular pacemaker were included in this study. Transthoracic apical LV images at equidistant intervals were obtained using a prototype, fast-rotating second harmonic transducer to reconstruct 3D LV datasets during sinus rhythm (SR), right ventricular (RV) apical and biventricular pacing mode. A semi-automated contour analysis system (4D LV analysis, TomTec, Germany) was used for segmental wall motion analysis and identification of the most delayed contracting segment and calculation of global LV function.


RESULTS
Data acquisition duration was 10 s and analyzable 3D images were obtained in 12 patients. Of these patients, data during SR were available in 9 and during biventricular pacing in 11. The greatest contraction delay during SR was found in the anterior and antero-septal segments in five of nine patients. Biventricular pacing resulted in reduction of the contraction delay in seven of eight patients. The global LV function did not change significantly.


CONCLUSIONS
3D echocardiography with appropriate analytic software allows detection of the most delayed LV contracting segment and can be used to select the optimal pacing site during resynchronization therapy.
Erasmus Medical Center, Thoraxcenter, Room H536, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Boudewijn J
BJ
Krenning
Tamas
T
Szili-Torok
Marco M
MM
Voormolen
Dominic A M J
DA
Theuns
Luc J
LJ
Jordaens
Charles T
CT
Lancée
Nico
N
De Jong
Anton F W
AF
Van Der Steen
Folkert J
FJ
Ten Cate
Jos R T C
JR
Roelandt
D000368:Aged; D002304:Cardiac Pacing, Artificial; D019560:Echocardiography, Three-Dimensional; D005240:Feasibility Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy