Cardiac imaging and non-invasive testing: Tissue Doppler velocity is superior to strain imaging in predicting long-term cardiovascular events after cardiac resynchronisation therapy

Zhang, Q.; van Bommel, R. J.; Fung, J. W.-H.; Chan, J. Y.-S.; Bleeker, G. B.; Ypenburg, C.; Yip, G.; Liang, Y.-j.; Schalij, M. J.; Bax, J. J.; Yu, C.-M.
July 2009
Heart;Jul2009, Vol. 95 Issue 13, p23
Academic Journal
Objective: To examine the predictive value of systolic dyssynchrony measured by tissue Doppler velocity versus tissue Doppler strain imaging on long-term outcome after cardiac resynchronisation therapy (CRT). Design: Cohort study. Setting: Two university hospitals. Patients: Two hundred and thirty-nine patients (65 (SD 12) years, 76% males) who underwent CRT. Interventions: Baseline echocardiography with tissue Doppler imaging (TDI) and clinical follow-up for 37 (20) months. Main outcome measures: The time to peak systolic velocity during ejection phase (Ts) and the time to peak systolic strain (Tϵ) were assessed for dyssynchrony, that is the maximal delay in Ts and the maximal delay in Tϵ among the four left ventricular basal segments. Occurrence of cardiovascular endpoints between patients with and without dyssynchrony was compared by Kaplan-Meier curves, followed by Cox regression analysis for potential predictor(s). Results: There were 78 (33%) deaths, with cardiovascular causes in 64 (27%) patients, while 136 (57%) patients were hospitalised for cardiovascular events, including decompensated heart failure in 87 (36%) patients. Patients with the maximal delay in Ts of ≥65 ms showed a lower event rate for cardiovascular mortality (19% vs 38%, logrank χ2 = 7.803, p = 0.005) and other prognostic endpoints. In Cox regression analysis, the maximal delay in Ts (hazard ratio (HR) 0.463, 95% CI 0.270 to 0.792, p = 0.005) and ischaemic aetiology (HR 2.716, 95% CI 1.505 to 4.901, p = 0.001) were independent predictors of cardiovascular mortality. In contrast, the maximal delay in Tϵ of ≥80 ms failed to predict any cardiovascular event. Conclusions: Echocardiographic evidence of prepacing systolic dyssynchrony measured by TDI velocity, but not TDI strain, predicted lower long-term cardiovascular events after CRT.


Related Articles

  • Heart Failure in Zambia: Evidence for Improving Clinical Practice. Goma, F. M. // Medical Journal of Zambia;2014, Vol. 41 Issue 1, p1 

    The author reflects on heart failure (HF) cases in Zambia hospitals. He commends the study which explores the factors which relate to mortality in patients with HF, need to understand the etiological factors and pathophysiological manifestations for the diagnosis and management of HF, and the...

  • Longitudinal two-dimensional strain rate imaging: a potential approach to predict the response to cardiac resynchronization therapy. Haoying Shi; Xianhong Shu; Fang Wang; Jie Cui; Haozhu Chen; Baogui Sun; Shaowen Liu // International Journal of Cardiovascular Imaging;Oct2009, Vol. 25 Issue 7, p677 

    The purpose of our study was to test the usefulness of speckle-tracking two-dimensional echocardiography (in particular longitudinal strain and strain rate) in predicting the response to cardiac resynchronization therapy. The standard approach has been tissue Doppler-based echocardiographic...

  • Echocardiography as a guidance in CRT management: the GPS system in a labyrinth? Baur, Leo H. B. // International Journal of Cardiovascular Imaging;Feb2010, Vol. 26 Issue 2, p193 

    Although progress has been made to understand the factors for non-responsiveness, fine tuning and comprehensive strategies are needed to make echocardiography the GPS system in cardiac resynchronization. Taking the wrong turn in the labyrinth of dyssynchrony is expensive and time consuming...

  • The syndrome of cardiac failure in adults with congenitally corrected transposition. Koželj, Mirta; Prokšelj, Katja; Berden, Pavel; Jan, Matevž; Osredkar, Joško; Bunc, Matjaž; Tretjak, Martin; Podnar, Tomaž // Cardiology in the Young;Dec2008, Vol. 18 Issue 6, p599 

    Objectives: To assess neurohormonal activation of cardiac failure in adults with congenitally corrected transposition, and to determine the most sensitive marker for recognition of the cardiac failure. Background: The onset of morphologically right ventricular dysfunction is unpredictable in...

  • Routine versus selective cardiac magnetic resonance in non-ischemic heart failure -- OUTSMART-HF: study protocol for a randomized controlled trial (IMAGE-HF (heart failure) project 1-B). Paterson, Ian; Wells, George A.; Ezekowitz, Justin A.; White, James A.; Friedrich, Matthias G.; Mielniczuk, Lisa M.; O¿Meara, Eileen; Chow, Benjamin; DeKemp, Rob A.; Klein, Ran; Dennie, Carole; Dick, Alexander; Coyle, Doug; Dwivedi, Girish; Rajda, Miroslaw; Wright, Graham A.; Laine, Mika; Hanninen, Helena; Larose, Eric; Connelly, Kim A. // Trials;2013, Vol. 14 Issue 1, p1 

    Background Imaging has become a routine part of heart failure (HF) investigation. Echocardiography is a first-line test in HF given its availability and it provides valuable diagnostic and prognostic information. Cardiac magnetic resonance (CMR) is an emerging clinical tool in the management of...

  • Orthotopic heart transplantation with donors greater than or equal to 60 years of age: a single-center experience Bruschi, Giuseppe; Colombo, Tiziano; Oliva, Fabrizio; Morici, Nuccia; Botta, Luca; Cannata, Aldo; Frigerio, Maria; Martinelli, Luigi // European Journal of Cardio-Thoracic Surgery;Jul2011, Vol. 40 Issue 1, pe55 

    Abstract: Objectives: Heart transplantation is the best therapeutic option for patients suffering from end-stage heart failure, but donor organ availability still represents a major problem. This had led to a shift toward extended donor criteria. The aim of the present study is to analyze the...

  • Predictors of response to cardiac resynchronization therapy: the holy grail of electrophysiology. Ismail, Haisam; Makaryus, Amgad N. // International Journal of Cardiovascular Imaging;Feb2010, Vol. 26 Issue 2, p197 

    The article presents authors' comments on the article related to both echocardiographic and clinical parameters for predicting response to Cardiac Resynchronization Therapy (CRT) published in this issue. It states that besides echo based parameters, perhaps clinical parameters like the medical...

  • Clinical features of mixed physiology of constriction and restriction: Echocardiographic characteristics and clinical outcome Yamada, Hirotsugu; Tabata, Tomotsugu; Jaffer, Sukaina J.; Drinko, Jeanne K.; Jasper, Susan E.; Lauer, Michael S.; Thomas, James D.; Klein, Allan L. // European Journal of Echocardiography;Jun2007, Vol. 8 Issue 3, p185 

    Abstract: Aims: An entity of patients with mixed physiology of constriction and restriction has been reported, however, the characteristics of these patients have not been well documented. We evaluated the clinical features and the outcome of these patients. Methods and results: Study subjects...

  • Prognostic Importance of the Right Ventricular Function Assessed by Doppler Tissue Imaging. Meluzı́n, J; Špinarová, L; Dušek, L; Toman, J; Hude, P; Krejčı́, J // European Journal of Echocardiography;2003, Vol. 4 Issue 4, p262 

    Aims: We sought to assess whether the peak systolic and diastolic tricuspid annular velocities as indicators of the right ventricular systolic and diastolic function are of prognostic importance in patients with symptomatic heart failure.Methods and Results: The study included 139 consecutive...


Read the Article


Sign out of this library

Other Topics