Background
Methods
Study population
Two-dimensional echocardiography and speckle-tracking echocardiography
Three-dimensional echocardiography and speckle-tracking echocardiography
Automatic longitudinal strain integrals – new application
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mean I L,peak and mean I L,avc represented the mean of I L,peak and I L,avc of all 17 LV segments, respectively.
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SDI L,peak and SDI L,avc were the standard deviation of the integrals of the strain signals I L,peak and I L,avc of all 17 segments, respectively. SDI L,peak and SDI L,avc corresponded to the energy dispersion for all 17 segments at the longitudinal strain peak and at the instant of aortic valve closure, respectively.
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DiffInt was calculated as the average of all 17 LV segments in terms of the difference between I L,avc and I L,peak for each segment. This value could be considered an indicator of the wasted energy developed by the ventricle after aortic valve closure.
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MSDI (maximal difference between strain peak instants) was calculated as the ratio of the time difference between the last and first strain peaks occurring during the cardiac cycle and the duration of the cardiac cycle.
Echocardiographic response
Statistical analysis
Results
Study population
All patients (n = 48) | CRT responders (n = 34, 71%) | CRT non-responders (n = 14, 29%) |
P value | |
---|---|---|---|---|
Age (years) | 65 ± 10 | 64 ± 10 | 65 ± 11 | 0.893 |
Male, n (%) | 30 (63%) | 18 (53%) | 12(86%) | 0.033* |
Ischemic etiology, n (%) | 15(31%) | 8 (24%) | 7 (50%) | 0.094 |
Heart rate (bpm) | 69 ± 12 | 68 ± 12 | 71 ± 11 | 0.489 |
QRS duration (ms) | 160 [160; 170] | 160 [160; 170] | 160 [153; 170] | 0.649 |
QRS & 150 ms, n (%) | 40 (83%) | 29 (85%) | 11 (79%) | 0.676 |
LBBB morphology, n (%) | 38 (79%) | 27 (79%) | 11 (79%) | 1 |
ACE inhibitors or AR blockers, n (%) | 46 (96%) | 33 (97%) | 13(93%) | 0.503 |
β-blockers, n (%) | 46 (96%) | 33 (97%) | 13(93%) | 0.503 |
Diuretics, n (%) | 28 (58%) | 16 (47%) | 12(86%) | 0.014* |
Antialdosterone, n (%) | 18(38%) | 14(41%) | 4 (29%) | 0.412 |
LVEF (%) | 26 ± 6 | 28 ± 5 | 23 ± 5 | 0.002* |
LVEDV (ml) | 225 ± 85 | 209 ± 78 | 265 ± 89 | 0.037* |
LVESV (ml) | 169 ± 68 | 152 ± 57 | 207 ± 78 | 0.009* |
Mitral regurgitation grade lll-IV, n (%) | 10(21%) | 7(21%) | 3(21%) | 0.0767 |
TAPSE (mm) | 21 + 4 | 21 ± 4 | 20 ± 5 | 0.78 |
GLS (%) | − 8.9 ± 3.6 | − 9.8 ± 3.4 | − 6.5 ± 3.1 | 0.003* |
Classical dyssynchrony echocardiographic parameters
All patients (n = 48) | CRT Responders (n = 34, 71%) | CRT Nonresponders (n = 14, 29%) |
p Value | |
---|---|---|---|---|
Atrioventricular dyssynchrony, n (%) | 23 (48%) | 16 (47%) | 7 (50%) | 0.853 |
IVMD >40 ms, n (%) | 38 (79%) | 31 (91%) | 7 (50%) | 0.003* |
LVPEI (ms) | 171 ± 27 | 175 ± 27 | 164 ± 28 | 0.189 |
DTI septo-lateral delay (ms) | 110 [74;161] | 114 [74;189] | 93 [72;117] | 0.162 |
Septal Flash, n (%) | 30 (63%) | 27 (79%) | 3 (21%) | 0.001* |
Mean strain peak (%) | −10.2 [−11.6;-9.2] | −10.6 [−11.7;-9.6] | −9.7 [−11.3;-8.4] | 0.302 |
SDtpeak (ms)
| 104 [80;123] | 101 [80;123] | 107 [66;121] | 0.626 |
Mean IL,peak (%.s-1)
| 1.68 ± 0.59 | 1.80 ± 0.62 | 1.39 ± 0.41 | 0.029* |
Mean I^avc (%.s−1) | 0.62 [0.34;0.90] | 0.76 [0.44;0.92] | 0.45 [0.24;0.77] | 0.129 |
SDIL,peak (%.s−1) | 1.09 [0.82;1.32] | 1.18 [0.96;1.35] | 0.83 [0.55;0.99] | 0.007* |
SDIL,avc (%.s-1) | 0.85 ± 0.37 | 0.90 ± 0.35 | 0.72 ± 0.39 | 0.125 |
DiffInt (%.s-1) | 0.57 ± 0.5 | 0.61 ± 0.47 | 0.47 ± 0.58 | 0.360 |
MSDI (ms) | 0.35 ± 0.16 | 0.37 ± 0.16 | 0.29 ± 0.14 | 0.106 |
Automatic analyses and 3D integral-derived longitudinal strain parameters
Predictors of echocardiographic response
Univariable OR (95% IC) |
p Value | Multivariable OR (95% IC) |
P value | |
---|---|---|---|---|
Female | 5.33 (1.03–27.5) | 0.046* | 1.64 (0.01–14.7) | 0.657 |
Non-ischemic etiology | 3.25 (0.87–12.1) | 0.079* | 5.33 (0.92–31.1) | 0.063Ŧ
|
LBBB morphology | 1.05 (0.23–4.83) | 0.948 | ||
QRS > 150 ms | 1.58 (0.32–7.76) | 0.572 | ||
GLS | 1.44 (1.11–1.89) | 0.007* | 1.22 (0.01–1.77) | 0.223 |
Atrioventricular dyssynchrony | 0.89 (0.26–3.09) | 0.853 | ||
IVMD >40 ms | 10.3 (2.12–50.3) | 0.004* | 4.35 (0.53–36) | 0.172 |
LVPEI | 1.02 (0.99–1.04) | 0.189 | ||
DTI septo-lateral delay | 1.01 (0.99–1.02) | 0.1 | ||
Septal Flash | 14.1 (3.08–64.9) | 0.001* | 14.1 (3.08–64.9) | 0.001Ŧ
|
SDt,peak | 49.1 (−) | 0.604 | ||
SDIL,peak | 18 (1.94–167) | 0.011* | 12.1 (0.81–180) | 0.078Ŧ
|
DiffInt | 0.55 (0.15–1.97) | 0.354 | ||
MSDI | 41.8 (0.42–4200) | 0.113 |
All patients without Septal flash (n = 18) | CRT responders without Septal flash (n = 7) | CRT non-responders without Septal flash (n = 11) |
P value | |
---|---|---|---|---|
SDIL,peak (%.s−1) | 0.90 ± 0.35 | 1.12 ± 0.26 | 0.77 ± 0.34 | 0.03* |
SDI
L,peak
> 1037%.s−1
| 7 (39%) | 5 (71%) | 2 (18%) | 0,049* |
Sensitivity | Specificity | Positive predictive value | Negative predictive value | Diagnostic accuracy | |
---|---|---|---|---|---|
septal flash | 79% | 79% | 90% | 61% | 0.79 |
SDI L,peak > 1.037%.s−1
| 70.6% | 7.6% | 88.9% | 52.4% | 0.73 |
SDI L,peak > 1.037%.s−1 S Septal Flash | 55.9% | 92.9% | 95% | 46.4% | 0.67 |
SDI L,peak > 1.037%.s−1 + AV | 29.4% | 92.9% | 90.9% | 35.1% | 0.48 |
SDI L,peak > 1.037%.s−1 + IV | 67.6% | 92.9% | 95.8% | 54.2% | 0.75 |
SDI L,peak > 1.037%.s−1 + AV + IV | 29.4% | 92.9% | 90.9% | 35.1% | 0.48 |
SDI L,peak > 1.037%.s−1 + AV + IV + Septal Flash | 23.5% | 100% | 100% | 35% | 0.46 |