Effects of global longitudinal strain and total scar burden on response to cardiac resynchronization therapy in patients with ischaemic dilated cardiomyopathy
1 Department of Cardiology, Second University of Naples, Martucci 35, 80121 Naples, Italy
2 Department of Cardiology, Monaldi Hospital, Naples, Italy
3 Dipartimento di Internistica Clinica e Sperimentale—Sezione Scientifica di Diagnostica per Immagini, Second University of Naples, Naples, Italy
4 Department of Interventional Cardiology, Santa Maria di Loreto Hospital, Naples, Italy
* Corresponding author. Tel: +39 (0) 817 618525, Fax: +39 (0) 817 145205, Email: antonellodandrea{at}libero.it
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Abstract |
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Aims: To evaluate whether quantification of the extent of scarred left ventricular (LV) tissue by speckle-tracking strain echo (2DSE) can predict response to cardiac resynchronization therapy (CRT) in patients with ischaemic dilated cardiomyopathy (DCM).
Methods and results: Forty-five patients (58.3 ± 8.3 years; 24 males) with ischaemic DCM scheduled for CRT, and 25 controls were studied. A week before implantation all the patients underwent standard Doppler echo, 2DSE, and contrast-enhanced magnetic resonance (MR). Clinical and echocardiographic evaluation was repeated 6 months after CRT. The patients were considered as responders to CRT if LV end-systolic volume decreased by 15%. In DCM patients, LV ejection fraction was 29.2 ± 5.1%. By evaluating the 765 segments with MR, subendocardial infarct was identified in 17.0% and transmural infarct in 18.3%. With 2DSE, the average global longitudinal strain (GLS) was –23.1 ± 3.6% in controls and –15.1 ± 5.1% in DCM (P = 0.001). GLS showed a close correlation with total scar burden using MR (r = 0.64, P < 0.001). At follow-up, patients were subdivided into responders (n = 30; 66.7%) and non-responders (n = 15; 33.3%) to CRT. GLS was significantly different in non-responders than in responders (GLS: –10.4 ± 5.1 in non-responders vs. –18.4 ± 14% in responders, P < 0.001). In a multivariable analysis, GLS (P < 0.0001) and radial intraventricular dyssynchrony (P < 0.001) were powerful independent determinants of response to CRT.
Conclusion: GLS is strongly associated with total scar burden assessed by MR, and is an excellent independent predictor of response to CRT.
Key Words: Heart failure • Resynchronization therapy • Ischaemic dilated cardiomyopathy • Two-dimensional strain imaging • Cardiac magnetic resonance • Myocardial scar • Global strain
Received April 23, 2008; Revised July 16, 2008; Accepted August 29, 2008
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