title: Comparison between tissue doppler imaging (TDI) and tissue synchronization imaging (TSI) in evaluation of left ventricular dyssynchrony in patients with advanced heart failure.
abstract: BACKGROUND
  Assessment of left ventricular (LV) dyssynchrony has an important role in optimizing the selection of cardiac resynchronization therapy (CRT) candidates. We compared a new semiautomatic echocardiographic modality, tissue synchronization imaging (TSI) with a manual method, color-coded tissue Doppler imaging (TDI), in the assessment of LV dyssynchrony in patients with heart failure (HF).
  
  
  METHODS
  Ninety-five patients (age = 54.5 ± 17.1 years, 66.3% male) with advanced HF (NYHA functional class ≥III and ejection-fraction ≤35%) were included in the study and evaluated echocardiographically. The time to regional peak systolic velocity (Ts) in six basal and six middle segments of the LV was measured manually using velocity curves from TDI and semiautomatically using TSI and seven parameters of systolic dyssynchrony were computed.
  
  
  RESULTS
  Overall, a moderate-to-good association was found between Ts derived by these two modalities, whereas the mean of Ts via TSI was significantly lower than that measured by TDI in many LV segments. The agreement between these two modalities in identifying LV dyssynchrony varied from weak to moderate according to various dyssynchrony indices. In comparison to the TDI-derived dyssynchrony indices, TSI showed a high sensitivity of more than 90% using Ts delay at the basal/all LV segments and the indices for their standard deviations (SD) for identifying LV dyssynchrony, whereas the highest specificity of 80% was achieved using the septal-lateral dyssynchrony index in the prediction of LV dyssynchrony.
  
  
  CONCLUSIONS
  With the aid of selected LV dyssynchrony indices, the TSI method may confer enough sensitivity for a speedy evaluation and initial screening of LV dyssynchrony in HF patients; however, the current technology of TSI does not seem specific enough to replace TDI in the evaluation of dyssynchrony.
authors: Electrophysiology Department             Research Department             Echocardiography Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
authors: Ali
authors: A
authors: Kazemisaeid
authors: Mehrnaz
authors: M
authors: Rezvanfard
authors: Hakimeh
authors: H
authors: Sadeghian
authors: Masoumeh
authors: M
authors: Lotfi Tokaldany
authors: Azam Safir
authors: AS
authors: Mardanloo
authors: Mahmood Sheikh
authors: MS
authors: Fathollahi
mesh_terms: D000465:Algorithms; D015150:Echocardiography, Doppler / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D006333:Heart Failure / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology