Visual assessment of left ventricular dyssynchrony using tissue synchronization imaging.
BACKGROUND
Tissue synchronizing imaging (TSI) allows visual detection of asynchronous myocardial contraction. Although it is a screening tool for the detection of left ventricular (LV) dyssynchrony, its use as a qualitative method to assess dyssynchrony has not been studied. We evaluated the correlation of the visual assessment of dyssynchrony using TSI with quantitative assessment, the value of visual assessment to predict reverse remodeling to cardiac resynchronization therapy (CRT).


METHODS
Echocardiograms from 100 consecutive patients were retrospectively evaluated. We compared visual TSI assessment with the qualitative assessment of dyssynchrony obtained by tissue Doppler imaging (TDI). The utility of visual assessment as a predictor of response to CRT was evaluated in 43 patients.


RESULTS
In 86% of the cases, visual assessment was possible, and reproducibility was unrelated to observer experience. Each grade of visual dyssynchrony corresponded to a range of values of time to peak velocity (TPV) gradient (p < 0.001). Grade >or=1 dyssynchrony by visual assessment had 90% sensitivity and 95% specificity to identify >or=65 ms TPV gradient of LV opposing walls, and 93% sensitivity and 70% specificity to predict reverse LV remodeling.


CONCLUSIONS
LV dyssynchrony may be visually assessed by TSI, which can also predict reverse LV remodeling.
Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, Calif, USA.
Simon
S
Biner
Asim M
AM
Rafique
Arik
A
Wolak
Kirsten
K
Tolstrup
Robert J
RJ
Siegel
D000368:Aged; D000704:Analysis of Variance; D002304:Cardiac Pacing, Artificial; D015331:Cohort Studies; D003952:Diagnostic Imaging / Q000379:methods; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D015588:Observer Variation; D011336:Probability; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000628:therapy*; D020257:Ventricular Remodeling