Practical and conceptual limitations of tissue Doppler imaging to predict reverse remodelling in cardiac resynchronisation therapy.
Eur J Heart Fail
; 10(3): 281-90, 2008 Mar.
Article
in En
| MEDLINE
| ID: mdl-18313357
ABSTRACT
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 > or =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.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Cardiac Pacing, Artificial
/
Echocardiography, Doppler
/
Ventricular Remodeling
/
Heart Failure
Type of study:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Eur J Heart Fail
Journal subject:
CARDIOLOGIA
Year:
2008
Document type:
Article
Affiliation country:
Netherlands