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European Journal of Heart Failure Advance Access originally published online on March 3, 2009
European Journal of Heart Failure 2009 11(4):391-399; doi:10.1093/eurjhf/hfp032
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Comparison of myocardial deformation and velocity dyssynchrony for identification of responders to cardiac resynchronization therapy

Donato Mele1,*, Tiziano Toselli1, Fabio Capasso2, Giuseppe Stabile2, Marcello Piacenti3, Massimo Piepoli4, Sara Giatti1, Catherine Klersy5, Luciano Sallusti6 and Roberto Ferrari1

1 Azienda Ospedaliero-Universitaria, Ferrara and Fondazione Salvatore Maugeri, Brescia, Corso Giovecca 203, 44100 Ferrara, Italy
2 Cardiac Unit, Casa di Cura S. Michele, Maddaloni, Italy
3 CNR Institute of Clinical Physiology, Pisa, Italy
4 Division of Cardiology, Ospedale Civile, Piacenza, Italy
5 Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
6 Clinical Department, Guidant, Milan, Italy

* Corresponding author. Tel: +39 0532 236269, Fax: +39 0532 236593, Email: donatomele{at}libero.it


  Abstract

Aims: It is unclear whether myocardial velocity or deformation indices of dyssynchrony are better at predicting response to cardiac resynchronization therapy (CRT). Therefore, two indices of left ventricular (LV) dyssynchrony based on myocardial velocity and deformation were compared to predict success of CRT.

Methods and results: Sixty patients with dilated cardiomyopathy, New York Heart Association class III–IV, LV ejection fraction (EF) ≤35%, QRS >120 ms underwent CRT. The standard deviation of the averaged time-to-peak longitudinal negative strain (T{varepsilon}-SD) and positive systolic velocity (Tv-SD) of 12 LV segments were calculated before and after 6 months of CRT. Responders were defined at month 6 by ≥20% EF increase and/or ≥15% end-systolic volume (ESV) decrease with respect to baseline. On univariable analysis, baseline T{varepsilon}-SD and Tv-SD were both significantly associated with CRT response; however, the area under the receiver operating characteristic curve was better for T{varepsilon}-SD. On bivariable analysis, only T{varepsilon}-SD retained an independent prognostic value for CRT response. Results of the analysis did not change when the logistic models were adjusted for aetiology.

Conclusion: Baseline dyssynchrony of longitudinal myocardial peak deformation (T{varepsilon}-SD) appears to be better than dyssynchrony of longitudinal myocardial peak systolic velocities (Tv-SD) for the identification of CRT responders.

Key Words: Heart failure • Cardiac resynchronization therapy • Biventricular pacing • Strain imaging • Doppler tissue imaging

Received August 26, 2008; Revised December 8, 2008; Accepted January 13, 2009


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