© 2008 European Society of Cardiology
Practical and conceptual limitations of tissue Doppler imaging to predict reverse remodelling in cardiac resynchronisation therapy
a Department of Cardiology, University Medical Centre Utrecht Heidelberglaan 100 3584 CX Utrecht, The Netherlands
b Department of Physiology, University of Maastricht Maastricht, The Netherlands
* Corresponding author. Department of Cardiology, E03.406, University Medical Centre Utrecht, P.O. Box 855500, 3508 GA Utrecht, The Netherlands. Tel.: +31 30 2506176; fax: +31 30 2516396. E-mail address: b.w.l.deboeck{at}umcutrecht.nl (B.W.L. De Boeck).
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Abstract |
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Background: Recent, conflicting results about the use of tissue Doppler imaging derived (TDI-) asynchrony indices to predict reverse remodelling after cardiac resynchronisation therapy (CRT) have raised questions about their physiological meaning and methodological limitations.
Methods: In 41 patients, baseline TDI-derived septal to lateral delays of peak velocities (TDI-SL), standard deviation of peak velocities over 12 segments (Ts-SD), and peak 2D longitudinal strain (strain-SL) were compared with volumetric response (reduction in end-systolic volume of 
15%) after at least 6 months of CRT. Timing of peak TDI velocities was compared to timing of 2DS velocities and strain-SL. Influence of sample position, transverse motion, and interobserver inconsistency of the chosen peak velocities was assessed. Diagnostic accuracy of TDI-based delays was compared to accuracy of visual and 2D strain-based assessment.
Results: After 7.0±3.2 months of CRT, 24 patients were classified as responders. TDI-SL and Ts-SD were similar between responders and nonresponders at baseline, did not predict response, and were unaffected by CRT. Visual asynchrony scoring and strain-SL were better predictors of response than TDI-SL and Ts-SD. TDI measurements were highly susceptible to sample location and transverse motion components and poorly correlated with the timing of longitudinal contraction. There was a considerably poor agreement between observers with regard to scoring of TDI-SL and Ts-SD.
Conclusion: TDI-based measurements of asynchrony do not appear robust predictors of volume response to CRT.
Key Words: Heart failure • Resynchronisation • Ventricular remodelling • Tissue Doppler imaging • Strain imaging
Received September 18, 2007; Revised January 2, 2008; Accepted February 4, 2008
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