title: Additive value of right ventricular dyssynchrony indexes in predicting the success of cardiac resynchronization therapy: a speckle-tracking imaging study.
abstract: BACKGROUND
  The purpose of our study was to analyze the evolution of left and right ventricular (LV, RV) parameters before and after cardiac resynchronization therapy (CRT) using speckle-tracking imaging (STI).
  
  
  RESULTS
  Eighty-one patients with dilated cardiomyopathy (New York Heart Association functional class III or IV), left bundle branch block (QRS ≥120 ms), and LV ejection fraction ≤35% were studied with STI echocardiography before and after CRT. LV longitudinal (LV-SD12-l), radial (LV-SD6-r), and circumferential (LV-SD6-c) intraventricular dyssynchrony and LV twist (LV-t) were determined. RV dyssynchrony (RV-SD6) was defined as the standard deviation of the 6 time to peak systolic strain values. At 6 months' follow-up after CRT, the degree of dyssynchrony correlated significantly with LV ejection fraction improvement and end-systolic volume reduction. In receiver operating characteristic curve analysis, the following variables predictive of successful CRT were obtained: LV-SD12-l (area under the curve [AUC] 0.69), LV-SD6-c (AUC 0.66), LV-SD6-r (AUC 0.79), LV-t (AUC 0.81), and RV-SD6+LV-SD6-r (AUC 0.83). By combining LV and RV intraventricular dyssynchrony (LV-SD12-l + LV-SD6-r + RV-SD6), the AUC was significantly improved to 0.89 (P < .005 compared with RV-SD6+LV-SD6-r; P < .001 compared with LV-t).
  
  
  CONCLUSIONS
  Our data show that assessment of RV dyssynchrony parameters has an incremental value in the evaluation of candidates for CRT and may supplement LV dyssynchrony information.
authors.affiliation: Sapienza University, Rome, Italy. vitar@tiscali.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Vitarelli
authors.forename: Pasquale
authors.initials: P
authors.lastname: Franciosa
authors.forename: Bich Lien
authors.initials: BL
authors.lastname: Nguyen
authors.forename: Lidia
authors.initials: L
authors.lastname: Capotosto
authors.forename: Antonio
authors.initials: A
authors.lastname: Ciccaglioni
authors.forename: Ysabel
authors.initials: Y
authors.lastname: Conde
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Iorio
authors.forename: Guglielmo
authors.initials: G
authors.lastname: De Curtis
authors.forename: Fiorella
authors.initials: F
authors.lastname: Caranci
authors.forename: Massimo
authors.initials: M
authors.lastname: Vitarelli
authors.forename: Pietro
authors.initials: P
authors.lastname: Lucchetti
authors.forename: Olga
authors.initials: O
authors.lastname: Dettori
authors.forename: Valentina
authors.initials: V
authors.lastname: De Cicco
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult