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Strain-time curve analysis by speckle tracking echocardiography in cardiac resynchronization therapy: Insight into the pathophysiology of responders vs. non-responders.

To AC, Benatti RD, Sato K, Grimm RA, Thomas JD, Wilkoff BL, Agler D, Popović ZB - Cardiovasc Ultrasound (2016)

Bottom Line: Global εlong was significantly lower in non-responders at pre CRT (p = 0.02) and only improved in responders (p = 0.04) after CRT.Pre CRT septal εlong -time curves in both groups showed early septal contraction with mid-systolic decrease, while lateral εlong showed early stretch followed by vigorous mid to late contraction.Lower εlong in the non-responders may account for their poor response to CRT.

View Article: PubMed Central - PubMed

Affiliation: Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.

ABSTRACT

Background: Patients with non-ischemic heart failure etiology and left bundle branch block (LBBB) show better response to cardiac resynchronization therapy (CRT). While these patients have the most pronounced left ventricular (LV) dyssynchrony, LV dyssynchrony assessment often fails to predict outcome. We hypothesized that patients with favorable outcome from CRT can be identified by a characteristic strain distribution pattern.

Methods: From 313 patients who underwent CRT between 2003 and 2006, we identified 10 patients who were CRT non-responders (no LV end-systolic volume [LVESV] reduction) with non-ischemic cardiomyopathy and LBBB and compared with randomly selected CRT responders (n = 10; LVESV reduction ≥15%). Longitudinal strain (εlong) data were obtained by speckle tracking echocardiography before and after (9 ± 5 months) CRT implantation and standardized segmental εlong-time curves were obtained by averaging individual patients.

Results: In responders, ejection fraction (EF) increased from 25 ± 9 to 40 ± 11% (p = 0.002), while in non-responders, EF was unchanged (20 ± 8 to 21 ± 5%, p = 0.57). Global εlong was significantly lower in non-responders at pre CRT (p = 0.02) and only improved in responders (p = 0.04) after CRT. Pre CRT septal εlong -time curves in both groups showed early septal contraction with mid-systolic decrease, while lateral εlong showed early stretch followed by vigorous mid to late contraction. Restoration of contraction synchrony was observed in both groups, though non-responder remained low amplitude of εlong.

Conclusions: CRT non-responders with LBBB and non-ischemic etiology showed a similar improvement of εlong pattern with responders after CRT implantation, while amplitude of εlong remained unchanged. Lower εlong in the non-responders may account for their poor response to CRT.

No MeSH data available.


Related in: MedlinePlus

Averaged normalized segmental longitudinal strain-time curves of septal and lateral segments in responders and non-responders to cardiac resynchronization therapy. The strain-time curves have lower amplitude in non-responders. Cardiac resynchronization therapy results in a more uniform shape of the strain-time curves with cardiac resynchronization therapy. Error bars represent standard errors. Pre: prior to start of cardiac resynchronization therapy; Post: 9 ± 5 months after the start of cardiac resynchronization therapy
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Fig3: Averaged normalized segmental longitudinal strain-time curves of septal and lateral segments in responders and non-responders to cardiac resynchronization therapy. The strain-time curves have lower amplitude in non-responders. Cardiac resynchronization therapy results in a more uniform shape of the strain-time curves with cardiac resynchronization therapy. Error bars represent standard errors. Pre: prior to start of cardiac resynchronization therapy; Post: 9 ± 5 months after the start of cardiac resynchronization therapy

Mentions: Figure 3 showed averaged εlong-time curves of 18 segments in responder and non-responder. Each panel showed pre- and post-CRT septal and lateral wall εlong-time curves of basal, mid, and apical segment for responders and non-responders. Pre- CRT, the basal and mid septal εlong-time curves demonstrated a pattern of early septal contraction with mid-systolic decrease, while basal and mid lateral εlong-time curves demonstrated an early stretch followed by vigorous mid to late contraction. Post-CRT, restoration of contraction synchrony was noted in both the septal and lateral segments. This pattern pre- and post-CRT was to a lesser extent observed in the posterior and anteroseptal walls respectively (Fig. 4) and was lost in the inferior and anterior walls (Fig. 5). While the shapes of the εlong-time curves were similar in responders and non-responders, these two groups differed markedly in amplitude, both pre- and post-CRT.Fig 3


Strain-time curve analysis by speckle tracking echocardiography in cardiac resynchronization therapy: Insight into the pathophysiology of responders vs. non-responders.

To AC, Benatti RD, Sato K, Grimm RA, Thomas JD, Wilkoff BL, Agler D, Popović ZB - Cardiovasc Ultrasound (2016)

Averaged normalized segmental longitudinal strain-time curves of septal and lateral segments in responders and non-responders to cardiac resynchronization therapy. The strain-time curves have lower amplitude in non-responders. Cardiac resynchronization therapy results in a more uniform shape of the strain-time curves with cardiac resynchronization therapy. Error bars represent standard errors. Pre: prior to start of cardiac resynchronization therapy; Post: 9 ± 5 months after the start of cardiac resynchronization therapy
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4835914&req=5

Fig3: Averaged normalized segmental longitudinal strain-time curves of septal and lateral segments in responders and non-responders to cardiac resynchronization therapy. The strain-time curves have lower amplitude in non-responders. Cardiac resynchronization therapy results in a more uniform shape of the strain-time curves with cardiac resynchronization therapy. Error bars represent standard errors. Pre: prior to start of cardiac resynchronization therapy; Post: 9 ± 5 months after the start of cardiac resynchronization therapy
Mentions: Figure 3 showed averaged εlong-time curves of 18 segments in responder and non-responder. Each panel showed pre- and post-CRT septal and lateral wall εlong-time curves of basal, mid, and apical segment for responders and non-responders. Pre- CRT, the basal and mid septal εlong-time curves demonstrated a pattern of early septal contraction with mid-systolic decrease, while basal and mid lateral εlong-time curves demonstrated an early stretch followed by vigorous mid to late contraction. Post-CRT, restoration of contraction synchrony was noted in both the septal and lateral segments. This pattern pre- and post-CRT was to a lesser extent observed in the posterior and anteroseptal walls respectively (Fig. 4) and was lost in the inferior and anterior walls (Fig. 5). While the shapes of the εlong-time curves were similar in responders and non-responders, these two groups differed markedly in amplitude, both pre- and post-CRT.Fig 3

Bottom Line: Global εlong was significantly lower in non-responders at pre CRT (p = 0.02) and only improved in responders (p = 0.04) after CRT.Pre CRT septal εlong -time curves in both groups showed early septal contraction with mid-systolic decrease, while lateral εlong showed early stretch followed by vigorous mid to late contraction.Lower εlong in the non-responders may account for their poor response to CRT.

View Article: PubMed Central - PubMed

Affiliation: Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.

ABSTRACT

Background: Patients with non-ischemic heart failure etiology and left bundle branch block (LBBB) show better response to cardiac resynchronization therapy (CRT). While these patients have the most pronounced left ventricular (LV) dyssynchrony, LV dyssynchrony assessment often fails to predict outcome. We hypothesized that patients with favorable outcome from CRT can be identified by a characteristic strain distribution pattern.

Methods: From 313 patients who underwent CRT between 2003 and 2006, we identified 10 patients who were CRT non-responders (no LV end-systolic volume [LVESV] reduction) with non-ischemic cardiomyopathy and LBBB and compared with randomly selected CRT responders (n = 10; LVESV reduction ≥15%). Longitudinal strain (εlong) data were obtained by speckle tracking echocardiography before and after (9 ± 5 months) CRT implantation and standardized segmental εlong-time curves were obtained by averaging individual patients.

Results: In responders, ejection fraction (EF) increased from 25 ± 9 to 40 ± 11% (p = 0.002), while in non-responders, EF was unchanged (20 ± 8 to 21 ± 5%, p = 0.57). Global εlong was significantly lower in non-responders at pre CRT (p = 0.02) and only improved in responders (p = 0.04) after CRT. Pre CRT septal εlong -time curves in both groups showed early septal contraction with mid-systolic decrease, while lateral εlong showed early stretch followed by vigorous mid to late contraction. Restoration of contraction synchrony was observed in both groups, though non-responder remained low amplitude of εlong.

Conclusions: CRT non-responders with LBBB and non-ischemic etiology showed a similar improvement of εlong pattern with responders after CRT implantation, while amplitude of εlong remained unchanged. Lower εlong in the non-responders may account for their poor response to CRT.

No MeSH data available.


Related in: MedlinePlus