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The International Journal of Cardiovascular Imaging

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08.01.2019 | Original Paper

Echocardiography for prediction of 6-month and late response to cardiac resynchronization therapy: implementation of stress echocardiography and comparative assessment along with widely used dyssynchrony indices

verfasst von: Emmanouil Poulidakis, Constantina Aggeli, Skevos Sideris, Eliza Sfendouraki, Iosif Koutagiar, Andreas Katsaros, Evangelos Giannoulis, Markos Koukos, Eleni Margioula, Stavroula Lagoudakou, Kostas Gatzoulis, Polychronis Dilaveris, Ioannis Kallikazaros, Stavroula Couloheri, Christodoulos Stefanadis, Dimitrios Tousoulis

Erschienen in: The International Journal of Cardiovascular Imaging | Ausgabe 2/2019

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Abstract

Non-response cardiac resynchronization therapy (CRT) remains an issue, despite the refinement of selection criteria. The purpose of this study was to investigate the role of stress echocardiography along with dyssynchrony parameters for identification of CRT responders or late responders. 106 symptomatic heart failure patients were examined before, 6 months and 2–4 years after CRT implementation. Inotropic contractile reserve (ICR) and inferolateral (IL) wall viability were studied by stress echocardiography. Dyssynchrony was assessed by: (1) Septal to posterior wall motion delay (SPWMD) by m-mode. (2) Septal to lateral wall delay (SLD) by TDI. (3) Interventricular mechanical delay (IVMD) by pulsed wave Doppler for (4) difference in time to peak circumferential strain (TmaxCS) by speckle tracking. (5) Apical rocking (ApR) and septal flash (SF) by visual assessment. At 6 months there were 54 responders, with 12 additional late responders. TmaxCS had the greatest predictive value with an area under curve (AUC) of 0.835, followed by the presence of both ICR and viability of IL wall (AUC 0.799), m-mode (AUC = 0.775) and presence of either ApR or SF (AUC = 0.772). Predictive ability of ApR and of ICR is augmented if late responders are also included. Performance of dyssynchrony parameters is enhanced, in patients with both ICR and IL wall viability. Stress echocardiography and dyssynchrony parameters are simple and reliable predictors of 6-month and late CRT response. A stepwise approach with an initial assessment of ICR and viability and, if positive, further dyssynchrony analysis, could assist decision making.

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Titel: Echocardiography for prediction of 6-month and late response to cardiac resynchronization therapy: implementation of stress echocardiography and comparative assessment along with widely used dyssynchrony indices
verfasst von: Emmanouil Poulidakis
Constantina Aggeli
Skevos Sideris
Eliza Sfendouraki
Iosif Koutagiar
Andreas Katsaros
Evangelos Giannoulis
Markos Koukos
Eleni Margioula
Stavroula Lagoudakou
Kostas Gatzoulis
Polychronis Dilaveris
Ioannis Kallikazaros
Stavroula Couloheri
Christodoulos Stefanadis
Dimitrios Tousoulis
Publikationsdatum: 08.01.2019
Verlag: Springer Netherlands
Erschienen in: The International Journal of Cardiovascular Imaging / Ausgabe 2/2019
Print ISSN: 1569-5794
Elektronische ISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-018-01520-6

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Echocardiography for prediction of 6-month and late response to cardiac resynchronization therapy: implementation of stress echocardiography and comparative assessment along with widely used dyssynchrony indices

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