title: New Automatic Tools to Identify Responders to Cardiac Resynchronization Therapy.
abstract: New echocardiographic parameters (apical rocking [AR], septal flash [SF]) are intended to detect patterns specific to responders to cardiac resynchronization therapy (CRT). The patterns are visually recognized and qualitatively described, requiring experience and training. Speckle-tracking echocardiography can reflect SF and AR by using newly developed, dedicated parameters, such as start systolic index (SSI) and peak longitudinal displacement (PLD). The aim of this study was to investigate whether SSI and PLD can identify potential CRT responders.
  
  
  
  In 125 patients, echocardiograms from before and 9 ± 3 months after CRT were retrospectively analyzed with dedicated EchoPAC prerelease software. From speckle-tracking baseline images, color-coded bull's-eye displays of SSI and PLD were generated. Cutoff values for both parameters were derived from 25 randomly selected patients and applied to the remaining 100 patients to identify CRT response, defined as a decrease in end-systolic volume of ≥15% during follow-up. The performance of SSI and PLD was compared with the visual assessment of AR and SF by expert and novice readers.
  
  
  
  Expert readers detected 77 patients with AR, identifying CRT responders with sensitivity and specificity of 85 ± 2% and 82 ± 2%, respectively. Novice readers reached 74 ± 7% sensitivity and 55 ± 11% specificity, while the sensitivity and specificity of the quantitative analysis were 72 ± 3% and 84 ± 4% for SSI and 80 ± 1% and 75 ± 2% for PLD, respectively.
  
  
  
  New speckle-tracking-based quantitative assessment of mechanical dyssynchrony by SSI and PLD performs comparably in identifying CRT responders as visual analysis by expert readers and performs significantly better than novice readers.
authors: Department of Cardiovascular Diseases, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium.
authors: Razvan O
authors: RO
authors: Mada
authors: GE Healthcare, Haifa, Israel.
authors: Peter
authors: P
authors: Lysyansky
authors: Department of Cardiovascular Diseases, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium.
authors: Jürgen
authors: J
authors: Duchenne
authors: "N Stancioiu" Heart Institute, Cluj-Napoca, Romania.
authors: Ruxandra
authors: R
authors: Beyer
authors: "N Stancioiu" Heart Institute, Cluj-Napoca, Romania.
authors: Cristina
authors: C
authors: Mada
authors: Department of Cardiology, Rehabilitation Hospital, Cluj-Napoca, Romania.
authors: Lucian
authors: L
authors: Muresan
authors: "N Stancioiu" Heart Institute, Cluj-Napoca, Romania.
authors: Horia
authors: H
authors: Rosianu
authors: "N Stancioiu" Heart Institute, Cluj-Napoca, Romania.
authors: Adela
authors: A
authors: Serban
authors: Department of Cardiology, St Vinzenz-Hospital, Cologne, Germany.
authors: Stefan
authors: S
authors: Winter
authors: Department of Cardiology, St Vinzenz-Hospital, Cologne, Germany.
authors: Wolfgang
authors: W
authors: Fehske
authors: Department of Cardiovascular Diseases, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium.
authors: Ivan
authors: I
authors: Stankovic
authors: Department of Cardiovascular Diseases, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium. Electronic address: jens-uwe.voigt@uzleuven.be.
authors: Jens-Uwe
authors: JU
authors: Voigt
mesh_terms: D000465:Algorithms; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D000069550:Machine Learning; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010363:Pattern Recognition, Automated / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012984:Software; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control*
keywords: Candidate selection; Cardiac resynchronization therapy; Speckle tracking