Clinical InvestigationImaging and Diagnostic TestingSimple regional strain pattern analysis to predict response to cardiac resynchronization therapy: Rationale, initial results, and advantages
Section snippets
Study population
A total of 67 consecutive patients with left ventricular (LV) ejection fraction (LVEF) ≤35%, QRS ≥120, LBBB, and New York Heart Association (NYHA) functional class II or III were included between early 2009 and late 2010. All patients received heart failure medication in maximal tolerated dosages, including angiotensin-converting enzyme inhibitors or angiotensin-receptor antagonists (100%), β-blockers (92%), and spironolactone (59%).
Exclusion criteria were significant primary valve disease,
Study population
Baseline characteristics and association with outcome are shown in Table I. CRT-D implantation was successful in all patients. One patient was excluded at 6 months because of suboptimal pace delivery of 82%. Forty-three patients (65%) were responders. Responders compared with nonresponders were more likely to have nonischemic heart disease, longer QRS duration, and a higher degree of LV dyssynchrony by TPSmax. At follow-up, responders showed significant LV reverse remodeling (LVESV decreased
Discussion
The main findings in the current study can be summarized as follows: (1) In all patients, 1 of the 2 patterns could be identified; (2) Identification of LV dyssynchrony by use of the classical pattern was highly predictive of response; (3) Prediction of response by pattern analysis was better than prediction by more common quantitative descriptors; and (4) LV remodeling was dependent on short-term redistribution in the septal and lateral strains, representing the early- and late-activated
Conclusion
The current study presents an easy and highly predictive method for identifying potential responders to CRT based upon previously described factors involved in activation delay–based dyssynchrony. Pattern analysis appears superior to time-to-peak methods of velocity and longitudinal strain based on identifying distinct patterns of contraction that reflect the link between abnormal electrical activation and mechanical dyssynchrony. In addition, our results indicate a key role for the short-term
Disclosures
Sources of funding: None.
Conflicts of interest: None declared.
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