title: Practical and conceptual limitations of tissue Doppler imaging to predict reverse remodelling in cardiac resynchronisation therapy.
abstract: BACKGROUND
  Recent, conflicting results about the use of tissue Doppler imaging derived (TDI-) asynchrony indices to predict reverse remodelling after cardiac resynchronisation therapy (CRT) have raised questions about their physiological meaning and methodological limitations.
  
  
  METHODS
  In 41 patients, baseline TDI-derived septal to lateral delays of peak velocities (TDI-SL), standard deviation of peak velocities over 12 segments (Ts-SD), and peak 2D longitudinal strain (strain-SL) were compared with volumetric response (reduction in end-systolic volume of > or =15%) after at least 6 months of CRT. Timing of peak TDI velocities was compared to timing of 2DS velocities and strain-SL. Influence of sample position, transverse motion, and interobserver inconsistency of the chosen peak velocities was assessed. Diagnostic accuracy of TDI-based delays was compared to accuracy of visual and 2D strain-based assessment.
  
  
  RESULTS
  After 7.0+/-3.2 months of CRT, 24 patients were classified as responders. TDI-SL and Ts-SD were similar between responders and nonresponders at baseline, did not predict response, and were unaffected by CRT. Visual asynchrony scoring and strain-SL were better predictors of response than TDI-SL and Ts-SD. TDI measurements were highly susceptible to sample location and transverse motion components and poorly correlated with the timing of longitudinal contraction. There was a considerably poor agreement between observers with regard to scoring of TDI-SL and Ts-SD.
  
  
  CONCLUSIONS
  TDI-based measurements of asynchrony do not appear robust predictors of volume response to CRT.
authors.affiliation: Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100 3584 CX Utrecht, The Netherlands. b.w.l.deboeck@umcutrecht.nl
authors.forename: Bart W L
authors.initials: BW
authors.lastname: De Boeck
authors.forename: Mathias
authors.initials: M
authors.lastname: Meine
authors.forename: Geert E
authors.initials: GE
authors.lastname: Leenders
authors.forename: Arco J
authors.initials: AJ
authors.lastname: Teske
authors.forename: Harry
authors.initials: H
authors.lastname: van Wessel
authors.forename: J Hans
authors.initials: JH
authors.lastname: Kirkels
authors.forename: Frits W
authors.initials: FW
authors.lastname: Prinzen
authors.forename: Pieter A
authors.initials: PA
authors.lastname: Doevendans
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Cramer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial; D015150:Echocardiography, Doppler / Q000379:methods*; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D015588:Observer Variation; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D020257:Ventricular Remodeling / Q000502:physiology*