Novel speckle-tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy.
BACKGROUND
Mechanical dyssynchrony is a potential means to predict response to cardiac resynchronization therapy (CRT). We hypothesized that novel echocardiographic image speckle tracking can quantify dyssynchrony and predict response to CRT.


RESULTS
Seventy-four subjects were studied: 64 heart failure patients undergoing CRT (aged 64+/-12 years, ejection fraction 26+/-6%, QRS duration 157+/-28 ms) and 10 normal controls. Speckle tracking applied to routine midventricular short-axis images calculated radial strain from multiple circumferential points averaged to 6 standard segments. Dyssynchrony from timing of speckle-tracking peak radial strain was correlated with tissue Doppler measures in 47 subjects (r=0.94, P<0.001; 95% CI 0.90 to 0.96). The ability of baseline speckle-tracking radial dyssynchrony (time difference in peak septal wall-to-posterior wall strain > or =130 ms) to predict response to CRT was then tested. It predicted an immediate increase in stroke volume in 48 patients studied the day after CRT with 91% sensitivity and 75% specificity. In 50 patients with long-term follow-up 8+/-5 months after CRT, baseline speckle-tracking radial dyssynchrony predicted a significant increase in ejection fraction with 89% sensitivity and 83% specificity. Patients in whom left ventricular lead position was concordant with the site of latest mechanical activation by speckle-tracking radial strain had an increase in ejection fraction from baseline to a greater degree (10+/-5%) than patients with discordant lead position (6+/-5%; P<0.05).


CONCLUSIONS
Speckle-tracking radial strain can quantify dyssynchrony and predict immediate and long-term response to CRT and has potential for clinical application.
Suffoletto
Matthew S
MS
The Cardiovascular Institute, University of Pittsburgh, Pittsburgh, PA 15213-2582, USA.
Dohi
Kaoru
K
Cannesson
Maxime
M
Saba
Samir
S
Gorcsan
John
J
D000328:Adult; D000368:Aged; D002304:Cardiac Pacing, Artificial; D016022:Case-Control Studies; D004452:Echocardiography / Q000379:methods* / Q000592:standards; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D012984:Software; D013318:Stroke Volume