The Predictive Value Of Echocardiography On Cardiac Resynchronization Therapy

Part ⅠThe Predictive Value of Speckle Tracking Imaging on Cardiac Resynchronization TherapyObjective:Cardiac resynchronization therapy (CRT) is an established treatment in advanced heart failure. The purpose of our study was to analyze the evolution of left and right ventricular parameters before and after CRT using speckle-tracking imaging (STI).Methods:Seventy-seven consecutive patients were evaluated prior to CRT implantation in our hospital. STI was performed before and 6 month after CRT. We measured left ventricular longitudinal strain (LS), circumferential strain (CS) and right ventricular longitudinal strain (RV-LS), and the standard deviation of time to peak related to the heart cycle (LS-SD, CS-SD, RV-LS-SD). The primary end-point was a composite of death from any cause or unplanned hospitalization for a major cardiovascular event. The secondary end-point was response to therapy, defined as LVESV decrease of> 15%.Results:Forty-two of seventy-seven patients (54.5%) were considered responders to CRT. The LVEDV and LVESV were significantly reduced (EDV from 234.0± 12.7ml to 201.6±93.5ml, ESV from 168.6±93.1ml to 120.5±81.5ml, p<0.05), and the LVEF was markedly improved (from 31.7±7.9% to 38.0±9.5%, p<0.01). The synchrony was improved (SPWMD from 152.5±80.7ms to 109.7±115.0 ms, IVMD from 38.4±27.4ms to 26.0±20.4ms, p<0.05, LS-SD from 12.2±3.4% to 10.1±3.6%, CS-SD from 12.2±4.4% to 8.8±4.7%, p<0.05). Compared the parameters of the responder with non-responder, LS-SD, CS-SD, RV-LS and RV-LS-SD had statistical difference. In receiver operating characteristic curve analysis (ROC), the following variables predictive of successful CRT were obtained LS-SD (AUC 0.757), CS-SD (AUC 0.699), RV-LS (AUC 0.679), RV-LS-SD (AUC 0.723). LV-LS-SD+RV-LS-SD> 14.8% had a sensitivity of 90.5%, specificity of 69.2% to predict CRT response, and the AUC was 0.771.Conclusions:CRT can improve both systolic function and synchrony of left and right ventricules. Assessment of RV dyssynchrony parameters has an incremental value in the evaluation of candidates for CRT and may supplement LV dyssynchrony information.Part II Real-Time Three-Dimensional Echocardiography on Cardiac Resynchronization TherapySection 1 The Predictive Value of Three-Dimensional Speckle Tracking Imaging on Cardiac Resynchronization TherapyObjective:Cardiac resynchronization therapy (CRT) is an established treatment in advanced heart failure. The purpose of our study was using three-dimensional speckle tracking imaging (3D-STI) to assessment the systolic function and synchrony after CRT, and to assess the predictive value on CRT.Methods:Seventy-four consecutive patients were evaluated prior to CRT implantation in our hospital.3D-STI was performed before and 6 month after CRT. We measured 3D strain (3DS), longitudinal strain (LS), circumferential strain (CS) and radial (RS) strain of LV. The LV dyssynchrony was evaluated by the standard deviation of time to peak negative value of 3D strain (3DS-SD) and time to minimum regional volume of 16 segments (SDI) related to the heart cycle. The primary end-point was a composite of death from any cause or unplanned hospitalization for a major cardiovascular event. The secondary end-point was response to therapy, defined as LVESV decrease of> 15%.Results:Forty of seventy-four patients (54%) were considered responders to CRT. The LVEDV and LVESV were significantly reduced (from 240.0±95.9ml to 181.7±85.8ml, from 194.9±89.1ml to 138.0±78.5ml, p<0.05), and the LVEF was markedly improved (from 19.8±6.6% to 27.2±9.5%, p<0.01). The left ventricular synchrony was improved (SDI from 13.8±6.6% to 10.3±3.1%, p<0.01,3DS-SD from 12.7±6.3% to 9.6±3.5%, p<0.05). On logistic regression analysis, preserved 3DS-SD and SDI were the independent predictors of response to CRT, the AUC were 0.78 and 0.75.3DS-SD> 8.1% had a sensitivity of 79%, specificity of 71% to predict CRT response. SDI> 10.1% had a sensitivity of 65%, specificity of 77% to predict CRT response.Conclusions:CRT can improve both systolic function and synchrony of left ventricular.3DS-SD and SDI were the independent predictors of response to CRT.Section 2 Evaluation of Right Ventricular Global and Regional Volume and Systolic Function on Cardiac Resynchronization Therapy Using Real-time Three-Dimensional EchocardiographyObjective:Right ventricular (RV) function has a critical role in determining the clinical outcome of using cardiac resynchronization therapy in patients with advanced heart failure. The purpose of our study was using real-time three-dimensional echocardiography (RT-3DE) to assess the RV function of patients with advanced heart failure, and to investigate the effect of CRTMethods:Forty consecutive patients prior to CRT implantation and twenty-eight age and gender matched normal controls were evaluated. We measured global and regional end-diastolic volume (EDV), end-systolic volume (ESV), systolic volume (SV) and ejection fraction (EF) in three compartments (inflow, body and outflow). The RV dyssynchrony parameters were evaluated by the standard deviation of time to minimum systolic volume (Tmsv-SD) and maximum difference of time to minimum regional volume (Tmsv-dif) related to the cardiac cycle.Results:RV global and regional EDV、ESV were larger and EF was lower in the heart failure group compared with controls, and there were no significant differences in SV between the two groups. The RV dyssynchrony parameters were higher than control group (Tmsv-SD:1.75±1.78% vs.0.40±0.37%, Tmsv-dif:3.28±3.24% vs. 0.80±0.74%, p<0.05). The systolic function and synchrony of right ventricular tended to be improved 6 months after CRT, but the improvement had not reached statistical difference.Conclusions:Both systolic function and synchrony of right ventricular was reduced in in the heart failure group. CRT tended to improve systolic function and synchrony of the right ventricule.