Circumferential 2D-strain imaging for the prediction of long term response to cardiac resynchronization therapy.
BACKGROUND
Cardiac Resynchronization Therapy (CRT) leads to hemodynamic and clinical improvement in heart failure patients. The established methods to evaluate myocardial asynchrony analyze longitudinal and radial myocardial function. This study evaluates the new method of circumferential 2D-strain imaging in the prediction of the long-term response to CRT.


RESULTS
38 heart failure patients (NYHA II-III, QRS > 120 ms, LVEF < 0.35) received CRT and echocardiographic evaluation with a mean follow-up of 9.4 months. 18 (47.4%) of the patients were hemodynamic responders to long-term CRT. In the responder group, the maximum delay in the circumferential 2D-strain in the basal segments decreased (246 +/- 94 to 123 +/- 92 ms, p < 0.001). In the non-responder group there was no significant change (pre CRT: 195 +/- 86, post CRT 135 +/- 136 ms, p = 0.84). This was paralleled by a reduction of the maximum delay in the radial and longitudinal 2D strain in the basal segments. In ROC analysis, the baseline delay of circumferential 2D strain (AUC 0.66 (+/- 0.14)) does not predict a long-term response to CRT (p = 0.37).


CONCLUSIONS
There is a significant decrease in the circumferential 2D-strain derived delays after CRT, indicating that resynchronization induces improvement in all three dimensions of myocardial contraction. However, the resulting predictive values of 2D strain delays are not superior to longitudinal and radial 2D-strain or TDI delays.
Universitätsmedizin Berlin, Medical Clinic for Cardiology and Angiology, Charité Campus Mitte, Charitéplatz 1, 10098 Berlin, Germany. fabian.knebel@charite.de
Fabian
F
Knebel
Sebastian
S
Schattke
Hansjürgen
H
Bondke
Stephan
S
Eddicks
Andrea
A
Grohmann
Gert
G
Baumann
Adrian C
AC
Borges
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D018618:Echocardiography, Doppler, Color / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010138:Pacemaker, Artificial; D011336:Probability; D012372:ROC Curve; D012720:Severity of Illness Index