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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

Comparison of opposing wall mechanics during ventricular contraction before and after cardiac resynchronization therapy (CRT). Strain values are measured at mid-systole (50 %), end-systole (100 %) and post-systole (125 %) before (upper panels) and >3 months after the start of CRT (lower panels). a Septal and lateral longitudinal wall strains; b Anteroseptal and posterior longitudinal wall strains; and c Inferior and anterior longitudinal wall strains. Error bars represent standard errors. CRT, cardiac resynchronization therapy
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Fig6: Comparison of opposing wall mechanics during ventricular contraction before and after cardiac resynchronization therapy (CRT). Strain values are measured at mid-systole (50 %), end-systole (100 %) and post-systole (125 %) before (upper panels) and >3 months after the start of CRT (lower panels). a Septal and lateral longitudinal wall strains; b Anteroseptal and posterior longitudinal wall strains; and c Inferior and anterior longitudinal wall strains. Error bars represent standard errors. CRT, cardiac resynchronization therapy

Mentions: Prior to CRT, εlong was lower in the lateral than in the septal wall (p = 0.001). Septal and lateral walls were also different in the pattern of εlong increase (p = 0.001; Fig. 6a). There was no difference between responders and non-responders in overall εlong, the pattern of εlong increase, or in the difference between εlong of opposing walls (p = NS for all). After CRT, lateral wall εlong was still higher (p = 0.007), but difference in the pattern of εlong increase disappeared (p = 0.80). Responders showed higher overall εlong (p = 0.02), and more marked εlong increase over time (p = 0.03).Fig 6


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)

Comparison of opposing wall mechanics during ventricular contraction before and after cardiac resynchronization therapy (CRT). Strain values are measured at mid-systole (50 %), end-systole (100 %) and post-systole (125 %) before (upper panels) and >3 months after the start of CRT (lower panels). a Septal and lateral longitudinal wall strains; b Anteroseptal and posterior longitudinal wall strains; and c Inferior and anterior longitudinal wall strains. Error bars represent standard errors. CRT, cardiac resynchronization therapy
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig6: Comparison of opposing wall mechanics during ventricular contraction before and after cardiac resynchronization therapy (CRT). Strain values are measured at mid-systole (50 %), end-systole (100 %) and post-systole (125 %) before (upper panels) and >3 months after the start of CRT (lower panels). a Septal and lateral longitudinal wall strains; b Anteroseptal and posterior longitudinal wall strains; and c Inferior and anterior longitudinal wall strains. Error bars represent standard errors. CRT, cardiac resynchronization therapy
Mentions: Prior to CRT, εlong was lower in the lateral than in the septal wall (p = 0.001). Septal and lateral walls were also different in the pattern of εlong increase (p = 0.001; Fig. 6a). There was no difference between responders and non-responders in overall εlong, the pattern of εlong increase, or in the difference between εlong of opposing walls (p = NS for all). After CRT, lateral wall εlong was still higher (p = 0.007), but difference in the pattern of εlong increase disappeared (p = 0.80). Responders showed higher overall εlong (p = 0.02), and more marked εlong increase over time (p = 0.03).Fig 6

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