Combined Assessment of Left Ventricular Dyssynchrony and Contractility by Speckled Tracking Strain Imaging: A Novel Index for Predicting Responders to Cardiac Resynchronization Therapy

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概要

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• <B>Background:</B> Mechanical dyssynchrony is an important factor in the response to cardiac resynchronization therapy (CRT). However, no echocardiographic measure can improve prediction of case selection for CRT.<BR><B>Objective:</B> The purpose of this study was to assess the efficacy of a newly combined echocardiographic index for ventricular dyssynchrony and contractility using speckled tracking strain analysis to predict responders to CRT.<BR><B>Methods:</B> Forty-seven patients with severe heart failure in New York Heart Association functional class III/IV, left ventricular ejection fraction ≤35%, and QRS duration ≥130 ms were included in the study. Echocardiography was performed, and a novel index (i-Index), the product of radial dyssynchrony and radial strain, was calculated. Responder to CRT was defined as a patient with a ≥15% decrease in left ventricular end-systolic volume at 6-month follow-up.<BR><B>Results:</B> Thirty-two patients (68%) were classified as responders. The i-Index was significantly higher in responders than in nonresponders (3,450±1,180 vs 1,481±841, P<.001). The area under receiver operator characteristic curve was 0.92 for the i-Index, which was better than the index of radial dyssynchrony only (0.74). A cutoff value of i-Index >2,000 predicted responders with 94% sensitivity and 80% specificity. The index using only radial dyssynchrony had 81≤% sensitivity and 53% specificity. Furthermore, i-Index decreased in responders (1,985±1,261, P<.001) but not in nonresponders (1,684±866, P=.48).<BR><B>Conclusion:</B> Our findings suggest that a novel combined index by radial strain echocardiography might be a predictor of response to CRT. The value of this novel echocardiographic index requires further assessment in larger studies.

著者

• Inden Yasuya

  Department Of Cardiology Nagoya University Graduate School Of Medicine

• Kitamura Kazuhisa

  Department Of Cardiology Nagoya University School Of Medicine

• Tsuji Yukiomi

  Department Of Cardiology Nagoya University Graduate School Of Medicine

• Shimano Masayuki

  Department Of Cardiology Nagoya University Graduate School Of Medicine

• Uchikawa Tomohiro

  Department of Cardiology, Nagoya University Graduate School of Medicine

• Shibata Rei

  Department Of Cardiology Nagoya University Graduate School Of Medicine

• Hirai Makoto

  Nagoya University School of Health Sciences

• Kamiya Hiromi

  Department of Cardiology, Nagoya University Graduate School of Medicine

• Uchikawa Tomohiro

  Department Of Cardiology Nagoya University Graduate School Of Medicine

• Kitamura Tomoya

  Department Of Cardiology Japanese Red Cross Nagoya 1st Hospital

• Kamiya Hiromi

  Department Of Cardiology Nagoya University Graduate School Of Medicine

• Ito Rieko

  Department Of Orthopaedic Surgery West Tokyo Metropolitan Police Hospital

• Murohara Toyoaki

  Department Of Cardiology Nagoya Graduate School Of Medicine

• YOSHIDA Naoki

  Department of Biomolecular Engineering, Tohoku University

• Ito Rieko

  Department of Cardiology, Nagoya University Graduate School of Medicine

• Hirai Makoto

  Nagoya University Graduate School of Health Science

• Kitamura Kazuhisa

  Department of Cardiology, Nagoya University Graduate School of Medicine

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