title: Utility of a new left ventricular asynchrony index as a predictor of reverse remodelling after cardiac resynchronization therapy.
abstract: OBJECTIVE
  The majority of tissue Doppler indexes proposed to predict left ventricular (LV) reverse remodelling in cardiac resynchronization therapy (CRT) reflects LV asynchrony as assessed in ejection phase. We evaluated the predictive value of a new strain-imaging parameter reflecting the total amount of time spent by 12 LV segments in contracting after aortic valve closure.
  
  
  RESULTS
  Fifty-nine patients who fulfilled current treatment recommendations were studied before and 6 months after CRT. Time to tissue Doppler systolic peak velocity (Ts) and time exceeding aortic closure (ExcT) in strain curves were measured in 12 LV segments. Ts standard deviation (Ts-SD) and sum of ExcT of overall 12 LV segments (oExcT) were analysed. After 6 months, responders were defined according to > or =15% LV end-systolic volume reduction. Responders (47%) when compared with non-responders (53%) had significantly higher baseline Ts-SD and oExcT values. Receiver operating characteristic (ROC) curve analysis demonstrated that an optimal cutoff value of 760 ms for oExcT yielded 93.5% sensitivity and 82.8% specificity. For Ts-SD at the cutoff of 32 ms, 82% sensitivity and 39% specificity were obtained. Area under ROC was significantly larger for oExcT than for Ts-SD.
  
  
  CONCLUSIONS
  o-ExcT is able to predict LV reverse remodelling after CRT.
authors.affiliation: Department of Heart and Vessels, University of Florence, Viale Morgagni 85, Florence 50134, Italy. cporciani@hotmail.com
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Porciani
authors.forename: Alessio
authors.initials: A
authors.lastname: Lilli
authors.forename: Roberto
authors.initials: R
authors.lastname: Macioce
authors.forename: Francesco
authors.initials: F
authors.lastname: Cappelli
authors.forename: Gabriele
authors.initials: G
authors.lastname: Demarchi
authors.forename: Alessia
authors.initials: A
authors.lastname: Pappone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ricciardi
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy*; D020257:Ventricular Remodeling / Q000502:physiology*