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- Title
Left ventricular discoordination index measured by speckle tracking strain rate imaging predicts reverse remodelling and survival after cardiac resynchronization therapy.
- Authors
Wang, Chun-Li; Powell, Brian D.; Redfield, Margaret M.; Miyazaki, Chinami; Fine, Nowell M.; Olson, Lyle J.; Cha, Yong-Mei; Espinosa, Raul E.; Hayes, David L.; Hodge, David O.; Lin, Grace; Friedman, Paul A.; Oh, Jae K.
- Abstract
Aims This study aimed to evaluate the predictive value of a baseline speckle tracking strain rate imaging-derived discoordination index for response to cardiac resynchronization therapy (CRT). Methods and results Ninety-seven patients with QRS ≥120 ms and left ventricular (LV) ejection fraction ≤35% were prospectively followed after CRT in the Mayo CRT Registry. The LV discoordination index (stretch/shortening or thinning/thickening during ejection) was calculated from three types of deformation, radial, circumferential, and longitudinal, using two-dimensional speckle tracking strain rate imaging. The benefit of CRT was evaluated by reverse remodelling (i.e. reduction of LV end-systolic volume ≥15% at 6-month follow-up) and survival. The optimal cut-off value of the baseline discoordination index in discriminating responders from non-responders was determined by receiver operating characteristic curve analysis. Significant differences in baseline indices between responders and non-responders were noted for radial and circumferential discoordination indices. A mid-ventricular radial discoordination index (RDI-M) >38% best predicted responders, especially in patients with ischaemic cardiomyopathy (area under the curve 0.86 for all patients, sensitivity 80%, and specificity 91%). Death occurred in 28 patients over a median follow-up of 3.2 years. When adjusted for confounding variables, lack of significant discoordination (RDI-M <38%) before CRT was associated with a particularly high mortality (hazard ratio 7.05, 95% confidence interval 2.45–26.0). Conclusion LV discoordination assessed by speckle tracking RDI-M imaging was able to predict reverse remodelling at 6 months and survival of patients who received CRT.
- Subjects
CARDIOMYOPATHIES; SENSITIVITY analysis; SENSITIVITY &; specificity (Statistics); MORTALITY; FOLLOW-up studies (Medicine); HEART diseases; MYOCARDIUM
- Publication
European Journal of Heart Failure, 2012, Vol 14, Issue 5, p517
- ISSN
1388-9842
- Publication type
Article
- DOI
10.1093/eurjhf/hfs025