M-mode Echocardiography,pulsed-wave Doppler and tissue Doppler imaging failed to predict cardiac resynchronization therapy responders / 中华超声影像学杂志

ABSTRACT

Objective To assess whether echocardiographic parameters of M-mode,pulsed-wave Doppler and tissue Doppler imaging which were usually used for selecting cardiac resynchronization therapy (CRT) candidates could predict CRT responders.Methods Twenty-nine patients with NYHA class Ⅲ or Ⅳ heart failure,left ventricular ejection fraction(LVEF)≤35%,QRS≥130 ms were enrolled.All of them underwent biventricular pacemaker implantation.The septal-to-posterior wall motion delay(SPWMD) from M-mode recording,and the standard deviation of time to peak systolic velocity(Ts-SD) were used to evaluate intraventricular dyssynchrony.The interventricular mechanical delay (IVMD) by pulsed Doppler echocardiography was calculated by subtracting the right ventricular preejection intervals (RV-PEI:the onset of the QRS on the electrocardiogram to the onset of pulmonary outflow) from the left ventricular preejection intervals (LV-PEI:the onset of the QRS on the electrocardiogram to the onset of aortic outflow).At least 15 % reduction in left ventricular end-systolic volume(LVESV) at the 6-month after CRT was defined as responder.Results In the 29 patients,there were 20 (68.97%) responders.The area under the receiver operating curve(ROC) of SPWMD,Ts-SD,LV-PEI,RV-PEI and IVMD to predict CRT responders was 0.448 (95% CI 0.184-0.712,P＞0.05),0.557 (95% CI 0.317-0.798,P＞0.05),0.479 (95% CI 0.186-0.773,P＞0.05),0.568 (95 % CI 0.272-0.863,P＞0.05) and 0.411 (95% CI0.136-0.687,P＞0.05),respectively.Conclusions M-mode echocardiography,pulsed Doppler and tissue Doppler imaging failed to predict CRT responders.New echocardiographic techniques including threedimensional echocardiography and speckle tracking image will be investigated,and may improve the predictive power.