Triplane tissue Doppler imaging: a novel three-dimensional imaging modality that predicts reverse left ventricular remodelling after cardiac resynchronisation therapy.
BACKGROUND
Several two-dimensional (2-D) tissue Doppler imaging (TDI) echocardiographic techniques have proved useful to identify responders to cardiac resynchronisation therapy (CRT). Recently a 3-D probe allowing simultaneous acquisition of TDI data in three imaging planes became available.


OBJECTIVE
To evaluate the value of triplane TDI to predict reverse left ventricular (LV) remodelling after CRT.


METHODS
Sixty patients with heart failure, scheduled for CRT, underwent triplane echocardiography with simultaneous TDI acquisition before and 6 months after implantation. From the triplane dataset a 3-D LV volume was generated and LV volumes and ejection fraction were calculated. Intraventricular dyssynchrony was quantitatively analysed by evaluating time from onset of the QRS complex to peak myocardial systolic velocity in 12 LV segments from the triplane dataset and calculation of the standard deviation (Ts-SD-12). Clinical response was defined as an improvement of at least one New York Heart Association class. Reverse LV remodelling was defined as >/=15% decrease of LV end-systolic volume at 6 months' follow-up.


RESULTS
Responders to CRT had significantly more LV dyssynchrony at baseline than non-responders (mean (SD) Ts-SD-12: 42 (14) vs 22 (12), p<0.001). A cut-off value of 33 ms for baseline Ts-SD-12, acquired from the triplane TDI dataset, yielded a sensitivity of 89% with a specificity of 82% to predict clinical response to CRT; sensitivity and specificity to predict reverse LV remodelling were 90% and 83%, respectively.


CONCLUSIONS
Triplane TDI echocardiography predicts clinical response and reverse LV remodelling 6 months after CRT implantation.
Van de Veire
N R
NR
Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands. nico.vandeveire@ugent.be
Yu
C-M
CM
Ajmone-Marsan
N
N
Bleeker
G B
GB
Ypenburg
C
C
De Sutter
J
J
Zhang
Q
Q
Fung
J W H
JW
Chan
J Y S
JY
Holman
E R
ER
van der Wall
E E
EE
Schalij
M J
MJ
Bax
J J
JJ
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D019560:Echocardiography, Three-Dimensional / Q000379:methods* / Q000592:standards; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology; D020257:Ventricular Remodeling / Q000502:physiology*