Purpose. Tissue Doppler imaging (TDI), speckle tracking imaging (STI), and radionuclide angioscintigraphy (RNA) have recently been proposed to assess mechanical dyssynchrony. It is unknown whether large differences exist between TDI, STI and RNA to evaluate inter- and intra-ventricular dyssynchrony and whether the results are interchangeable. Methods. Forty-three patients with dilated cardiomyopathy (NYHA class III or IV), left bundle branch block (QRS ≥120ms), and LV ejection fraction ≤35% were studied with triplane TDI and STI echocardiography (Vivid 9 ultrasound system, GE, Horten, Norway) and RNA before and after biventricular pacing (CRT). Intraventricular dyssynchrony was determined as the difference between the longest and shortest electromechanical coupling times in the basal septal/lateral, and anterior/posterior LV segments. Interventricular dyssynchrony was determined as the difference between electromechanical coupling times in the basal lateral RV segment and the most delayed LV segment. On line continuous LV volume changings were recorded using RNA and interventricular delay and basal-apical contraction were obtained. Results. At six months follow-up after implantation, patients functional status improved by one NYHA class or more and LVEF improved overall from 21.2±6.2% to 29.9±10.7%. Interventricular dyssynchrony was reduced from 72±22.5 ms to 26.7±14.1 ms by triplane TDI (p<0.005) and from 74±21.4 ms to 24.1±10.7 ms by STI (p<0.005). Intraventricular dyssynchrony by triplane TDI was reduced from 78.4±25 ms to 31.7±18.8 ms (p<0.001) and by STI from 81.1±27 ms to 29.5±18.8 ms (p<0.001). Interventricular dyssynchrony by RNA was reduced from 69.2±24.3 ms to 31.9±15.2 ms (p<0.005) and apicobasal intraventricular dyssynchrony from 74.2±24.4 ms to 35.8±17.3 ms (p<0.005). Triplane TDI and STI parameters had optimal predictive accuracy of the effects of CRT on LV function and a larger area under the receiver operating characteristic curve than the QRS duration and RNA parameters. Overall agreement between TDI and STI was 93% (k= 0.72) and between TDI and RNA was 82% (k= 0.64). Conclusions. Triplane TDI, STI and RNA dyssynchrony measurements have an acceptable observer variability but echo techniques a better predictive accuracy of the effects of CRT
Assessment of ventricular dyssynchrony in patients with heart failure: comparison among triplane tissue Doppler echocardiography, speckle tracking imaging and radionuclide angiocardiography / Vitarelli, Antonino; Franciosa, P; Nguyen, BICH LIEN; Battaglia, Daniela; Padella, V; Caranci, Fiorella; Capotosto, Lidia; Massa, Rita; CORTES MORICHETTI, M; Rosanio, S.. - In: EUROPEAN JOURNAL OF HEART FAILURE. - ISSN 1388-9842. - STAMPA. - 9(Suppl):(2010), p. S92. (Intervento presentato al convegno Heart Failure 2010 Meeting, Berlin, Germany tenutosi a Berlin, Germany nel 29May-01June 2010).
Assessment of ventricular dyssynchrony in patients with heart failure: comparison among triplane tissue Doppler echocardiography, speckle tracking imaging and radionuclide angiocardiography.
VITARELLI, Antonino;NGUYEN, BICH LIEN;BATTAGLIA, DANIELA;CARANCI, FIORELLA;CAPOTOSTO, LIDIA;MASSA, Rita;
2010
Abstract
Purpose. Tissue Doppler imaging (TDI), speckle tracking imaging (STI), and radionuclide angioscintigraphy (RNA) have recently been proposed to assess mechanical dyssynchrony. It is unknown whether large differences exist between TDI, STI and RNA to evaluate inter- and intra-ventricular dyssynchrony and whether the results are interchangeable. Methods. Forty-three patients with dilated cardiomyopathy (NYHA class III or IV), left bundle branch block (QRS ≥120ms), and LV ejection fraction ≤35% were studied with triplane TDI and STI echocardiography (Vivid 9 ultrasound system, GE, Horten, Norway) and RNA before and after biventricular pacing (CRT). Intraventricular dyssynchrony was determined as the difference between the longest and shortest electromechanical coupling times in the basal septal/lateral, and anterior/posterior LV segments. Interventricular dyssynchrony was determined as the difference between electromechanical coupling times in the basal lateral RV segment and the most delayed LV segment. On line continuous LV volume changings were recorded using RNA and interventricular delay and basal-apical contraction were obtained. Results. At six months follow-up after implantation, patients functional status improved by one NYHA class or more and LVEF improved overall from 21.2±6.2% to 29.9±10.7%. Interventricular dyssynchrony was reduced from 72±22.5 ms to 26.7±14.1 ms by triplane TDI (p<0.005) and from 74±21.4 ms to 24.1±10.7 ms by STI (p<0.005). Intraventricular dyssynchrony by triplane TDI was reduced from 78.4±25 ms to 31.7±18.8 ms (p<0.001) and by STI from 81.1±27 ms to 29.5±18.8 ms (p<0.001). Interventricular dyssynchrony by RNA was reduced from 69.2±24.3 ms to 31.9±15.2 ms (p<0.005) and apicobasal intraventricular dyssynchrony from 74.2±24.4 ms to 35.8±17.3 ms (p<0.005). Triplane TDI and STI parameters had optimal predictive accuracy of the effects of CRT on LV function and a larger area under the receiver operating characteristic curve than the QRS duration and RNA parameters. Overall agreement between TDI and STI was 93% (k= 0.72) and between TDI and RNA was 82% (k= 0.64). Conclusions. Triplane TDI, STI and RNA dyssynchrony measurements have an acceptable observer variability but echo techniques a better predictive accuracy of the effects of CRTI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
