Simple regional strain pattern analysis to predict response to cardiac resynchronization therapy: rationale, initial results, and advantages

TY - JOUR

T1 - Simple regional strain pattern analysis to predict response to cardiac resynchronization therapy

T2 - rationale, initial results, and advantages

AU - Risum, Niels

AU - Jons, Christian

AU - Olsen, Niels T

AU - Hansen, Thomas Fritz

AU - Bruun, Niels E

AU - Hojgaard, Michael V

AU - Valeur, Nana

AU - Kronborg, Mads

AU - Kisslo, Joseph

AU - Sogaard, Peter

N1 - Copyright © 2012 Mosby, Inc. All rights reserved.

PY - 2012/4

Y1 - 2012/4

N2 - Background: A classical strain pattern of early contraction in one wall and prestretching of the opposing wall followed by late contraction has previously been associated with left bundle branch block (LBBB) activation and short-term response to cardiac resynchronization therapy (CRT). Aims of this study were to establish the long-term predictive value of an LBBB-related strain pattern and to identify changes in contraction patterns during short-term and long-term CRT. Methods and Results: Sixty-seven patients with standard CRT criteria were prospectively enrolled between early 2009 and late 2010. Echocardiography including regional strain analysis by 2-dimensional speckle tracking was performed 1 week before implantation, at day 1, and 6 months after. Response was defined as a decrease in left ventricular end-systolic volume ≥ 15%. The predictive ability of a classical pattern was compared with time-to-peak measurements from velocity and deformation analysis. Forty-three patients (65%) were classified as responders. The presence of a classical pattern showed 91% specificity and 95% sensitivity for response and performed significantly better than time-to-peak parameters in prediction of response to CRT (P <.001, all). In responders, CRT acutely increased septal longitudinal peak systolic strain (-8.7% ± 3.6% to -11.1% ± 3%, P <.001) but not in nonresponders. Conclusions: The classical pattern is highly predictive of response to CRT and superior to time-to-peak methods. Patients who obtain long-term reverse remodeling are characterized by short-term reversal of the classical strain pattern. These findings emphasize the value of recognizing potentially reversible strain patterns in selection of CRT candidates.

AB - Background: A classical strain pattern of early contraction in one wall and prestretching of the opposing wall followed by late contraction has previously been associated with left bundle branch block (LBBB) activation and short-term response to cardiac resynchronization therapy (CRT). Aims of this study were to establish the long-term predictive value of an LBBB-related strain pattern and to identify changes in contraction patterns during short-term and long-term CRT. Methods and Results: Sixty-seven patients with standard CRT criteria were prospectively enrolled between early 2009 and late 2010. Echocardiography including regional strain analysis by 2-dimensional speckle tracking was performed 1 week before implantation, at day 1, and 6 months after. Response was defined as a decrease in left ventricular end-systolic volume ≥ 15%. The predictive ability of a classical pattern was compared with time-to-peak measurements from velocity and deformation analysis. Forty-three patients (65%) were classified as responders. The presence of a classical pattern showed 91% specificity and 95% sensitivity for response and performed significantly better than time-to-peak parameters in prediction of response to CRT (P <.001, all). In responders, CRT acutely increased septal longitudinal peak systolic strain (-8.7% ± 3.6% to -11.1% ± 3%, P <.001) but not in nonresponders. Conclusions: The classical pattern is highly predictive of response to CRT and superior to time-to-peak methods. Patients who obtain long-term reverse remodeling are characterized by short-term reversal of the classical strain pattern. These findings emphasize the value of recognizing potentially reversible strain patterns in selection of CRT candidates.

U2 - 10.1016/j.ahj.2012.01.025

DO - 10.1016/j.ahj.2012.01.025

M3 - Journal article

SN - 0002-8703

VL - 163

SP - 697

EP - 704

JO - American Heart Journal

JF - American Heart Journal

IS - 4

ER -