PURPOSE. The purpose of our study was to analyse the evolution of left ventricular (LV) and right ventricular (RV) parameters before and after cardiac resynchronization therapy (CRT) using tissue Doppler imaging (TDI) and speckle tracking imaging (STI). We hypothesized that alterations in radial and rotational mechanics as assessed by STI could add new aspects to the understanding of LV as well as RV dyssynchrony. METHODS. Thirty-one patients with dilated cardiomyopathy (NYHA class II or greater), left bundle branch block (QRS ≥120ms), and LV ejection fraction ≤35% were studied with TDI and STI echocardiography before and after CRT. RV and LV dyssynchrony were determined as the difference in time-to-peak strain from interventricular septum (IVS) to RV free wall and from IVS to LV lateral wall and interventricular dyssynchrony was calculated. LV longitudinal intraventricular dyssynchrony (LV-ld) in apical views and LV radial intraventricular dyssynchronyd(LV-rd) in parasternal short-axis view were determined. Averaged LV rotation and rotational velocities from the base and apex were also measured by STI (EchoPAC, GE Ultrasound) and used for calculation of LV torsion (LV-t). RESULTS. At six months follow-up after CRT, interventricular dyssynchrony by STI was reduced from 81.3±28 ms to 35.8±21.5 ms (p<.005), LV-ld from 78±30.6 ms to 26.1±14.8 ms (p<.005), and LV-rd from 123.8±59.7 ms to 31.2±15.9 ms (p<.001). LV apical-basal rotation delay was reduced from 137±89.4 ms to 62±18.7 ms (p<.001). Dyssynchrony from timing of STI peak radial strain was correlated with TDI measurements (r=0.83, p<.005). In receiver operating characteristic curve analysis, the following variables predictive of successful CRT were obtained: interventricular dyssynchrony (AUC 0.65), LV-ld (AUC 0.71), LV-rd (AUC 0.79), and LV-t dyssynchrony (AUC 0.82). By combining LV and RV intraventricular dyssynchrony, the AUC was significantly improved to 0.89 (p<.001 compared to LV-rd, p<.005 compared to LV-t). CONCLUSIONS. Our data show that rotation and radial parameters have an incremental value in the evaluation of candidates for CRT. The assessment of RV dyssynchrony may supplement LV dyssynchrony information.
Quantitative assessment of left and right ventricular dyssynchrony by tissue Doppler and speckle tracking imaging before and after cardiac resynchronization therapy / Vitarelli, Antonino; P., Franciosa; Y., Conde; D'Orazio, Simona; Stellato, Simona; Battaglia, Daniela; Caranci, Fiorella; Continanza, Giovanna; Dettori, Olga; Capotosto, Lidia; S., Rosanio. - In: EUROPEAN JOURNAL OF HEART FAILURE. - ISSN 1388-9842. - STAMPA. - 8(Suppl.):(2009), p. 461. (Intervento presentato al convegno Heart Failure 2009 Meeting, Nice, France tenutosi a Nice, France nel 30 May -2 June 2009).
Quantitative assessment of left and right ventricular dyssynchrony by tissue Doppler and speckle tracking imaging before and after cardiac resynchronization therapy
VITARELLI, Antonino;D'ORAZIO, SIMONA;STELLATO, SIMONA;BATTAGLIA, DANIELA;CARANCI, FIORELLA;CONTINANZA, GIOVANNA;DETTORI, OLGA;CAPOTOSTO, LIDIA;
2009
Abstract
PURPOSE. The purpose of our study was to analyse the evolution of left ventricular (LV) and right ventricular (RV) parameters before and after cardiac resynchronization therapy (CRT) using tissue Doppler imaging (TDI) and speckle tracking imaging (STI). We hypothesized that alterations in radial and rotational mechanics as assessed by STI could add new aspects to the understanding of LV as well as RV dyssynchrony. METHODS. Thirty-one patients with dilated cardiomyopathy (NYHA class II or greater), left bundle branch block (QRS ≥120ms), and LV ejection fraction ≤35% were studied with TDI and STI echocardiography before and after CRT. RV and LV dyssynchrony were determined as the difference in time-to-peak strain from interventricular septum (IVS) to RV free wall and from IVS to LV lateral wall and interventricular dyssynchrony was calculated. LV longitudinal intraventricular dyssynchrony (LV-ld) in apical views and LV radial intraventricular dyssynchronyd(LV-rd) in parasternal short-axis view were determined. Averaged LV rotation and rotational velocities from the base and apex were also measured by STI (EchoPAC, GE Ultrasound) and used for calculation of LV torsion (LV-t). RESULTS. At six months follow-up after CRT, interventricular dyssynchrony by STI was reduced from 81.3±28 ms to 35.8±21.5 ms (p<.005), LV-ld from 78±30.6 ms to 26.1±14.8 ms (p<.005), and LV-rd from 123.8±59.7 ms to 31.2±15.9 ms (p<.001). LV apical-basal rotation delay was reduced from 137±89.4 ms to 62±18.7 ms (p<.001). Dyssynchrony from timing of STI peak radial strain was correlated with TDI measurements (r=0.83, p<.005). In receiver operating characteristic curve analysis, the following variables predictive of successful CRT were obtained: interventricular dyssynchrony (AUC 0.65), LV-ld (AUC 0.71), LV-rd (AUC 0.79), and LV-t dyssynchrony (AUC 0.82). By combining LV and RV intraventricular dyssynchrony, the AUC was significantly improved to 0.89 (p<.001 compared to LV-rd, p<.005 compared to LV-t). CONCLUSIONS. Our data show that rotation and radial parameters have an incremental value in the evaluation of candidates for CRT. The assessment of RV dyssynchrony may supplement LV dyssynchrony information.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
