Pacing and clinical electrophysiology : PACE · 2019
Discontinuous contraction in the left ventricle assessed by 2-D speckle tracking echocardiography benefits from CRT.
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Fujii Aya, Inden Yasuya, Yanagisawa Satoshi, Mamiya Keita, Okamoto Hiroya, Sakamoto Yusuke, Tomomatsu Toshiro, Shibata Rei, Murohara Toyoaki
Аннотация
BACKGROUND: Cardiac resynchronization therapy (CRT) improves the morbidity and mortality rate in patients with left bundle-branch block (LBBB); however, some LBBB patients are non-responders for CRT. Previous studies have shown that a transmural functional line block alters the left ventricular (LV) activation sequence, and that the presence of a line block is predictive for responders. We investigated whether responders could be predicted in patients with LBBB by 2-dimensional (2-D) speckle tracking strain imaging.
METHODS: We enrolled 54 patients with LBBB, who underwent echocardiography before and 6 months after CRT implantation. A responder was defined by a decrease in the LV end-systolic volume >15% at the 6-month follow-up. We calculated a difference in the time from QRS onset to maximum strain between adjacent segments and defined the Tmax-diff as the maximum difference among six intersegments. We compared the Tmax-diff between responders and non-responders.
RESULTS: Among 54 patients, 37 patients were identified as responders. The Tmax-diff of the responders was significantly longer than that of the non-responders (309.6 ± 168.6 ms vs 181.5 ± 138.4 ms, P = .009). Furthermore, Tmax-diff ≥ 195 ms was higher in the septal and the anterior area. And patients with a Tmax-diff ≥ 195 ms tended to be responders (P = .02).
CONCLUSION: The present study showed that discontinuous contraction of the LV could be detected in CRT responders by 2-D speckle tracking strain imaging, which may be a useful tool to identify the contraction pattern of patients with LBBB and predict CRT responders.
METHODS: We enrolled 54 patients with LBBB, who underwent echocardiography before and 6 months after CRT implantation. A responder was defined by a decrease in the LV end-systolic volume >15% at the 6-month follow-up. We calculated a difference in the time from QRS onset to maximum strain between adjacent segments and defined the Tmax-diff as the maximum difference among six intersegments. We compared the Tmax-diff between responders and non-responders.
RESULTS: Among 54 patients, 37 patients were identified as responders. The Tmax-diff of the responders was significantly longer than that of the non-responders (309.6 ± 168.6 ms vs 181.5 ± 138.4 ms, P = .009). Furthermore, Tmax-diff ≥ 195 ms was higher in the septal and the anterior area. And patients with a Tmax-diff ≥ 195 ms tended to be responders (P = .02).
CONCLUSION: The present study showed that discontinuous contraction of the LV could be detected in CRT responders by 2-D speckle tracking strain imaging, which may be a useful tool to identify the contraction pattern of patients with LBBB and predict CRT responders.