title: Value of tissue Doppler echocardiography in predicting response to cardiac resynchronization therapy in patients with heart failure.
abstract: Several studies have demonstrated a relation between left ventricular (LV) dyssynchrony and response to cardiac resynchronization therapy (CRT). Many methods of determining LV dyssynchrony have been proposed, including a value of 65 ms as assessed by tissue Doppler imaging. The aim of the present validation study was to prospectively test the predictive accuracy of the 65-ms cutoff for LV dyssynchrony in a large cohort of patients with heart failure undergoing CRT. The study included 361 patients who had undergone CRT. The clinical and echocardiographic parameters were assessed at baseline and at 6 months of follow-up. The clinical response was defined as an improvement of > or = 1 New York Heart Association class, and the echocardiographic response was defined as a reduction in LV end-systolic volume of > or = 15%. At 6 months of follow-up, 259 patients (72%) had a clinical response and 187 patients (52%) had an echocardiographic response. The patients with a response had more LV dyssynchrony than did those without a response (91 + or - 49 ms vs 50 + or - 44 ms for the clinical response and 101 + or - 46 ms vs 55 + or - 45 ms for the echocardiographic response). On multivariate analysis, LV dyssynchrony remained predictive of the response, independent of other characteristics. In conclusion, LV dyssynchrony of > or = 65 ms was an independent predictor of both the clinical and the echocardiographic response in patients with heart failure who underwent CRT in this validation study.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Rutger J
authors.initials: RJ
authors.lastname: Van Bommel
authors.forename: Claudia
authors.initials: C
authors.lastname: Ypenburg
authors.forename: C Jan Willem
authors.initials: CJ
authors.lastname: Borleffs
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.forename: Nina Ajmone
authors.initials: NA
authors.lastname: Marsan
authors.forename: Matteo
authors.initials: M
authors.lastname: Bertini
authors.forename: Eduard R
authors.initials: ER
authors.lastname: Holman
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
mesh_terms: D000368:Aged; D002306:Cardiac Volume; D017147:Defibrillators, Implantable; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D004554:Electric Countershock / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome