6 March 2009 Novel echocardiographic prediction of non-response to cardiac resynchronization therapy
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Abstract
Imaging techniques try to identify patients who may respond to cardiac resynchronization therapy (CRT). However, it may be clinically more useful to identify patients for whom CRT would not be beneficial as the procedure would not be indicated for this group. We developed a novel, clinically feasible and technically-simple echocardiographic dyssynchrony index and tested its negative predictive value. Subjects with standard indications for CRT had echo preand post-device implantation. Atrial-ventricular dyssynchrony was defined as a left ventricular (LV) filling time of <40% of the cardiac cycle. Intra-ventricular dyssynchrony was quantified as the magnitude of LV apical rocking. The apical rocking was measured using tissue displacement estimates from echo data. In a 4-chamber view, a region of interest was positioned within the apical end of the middle segment within each wall. Tissue displacement curves were analyzed with custom software in MATLAB. Rocking was quantified as a percentage of the cardiac cycle over which the displacement curves showed discordant behavior and classified as non-significant for values <35%. Validation in 50 patients showed that absence of significant LV apical rocking or atrial-ventricular dyssynchrony was associated with non-response to CRT. This measure may therefore be useful in screening to avoid non-therapeutic CRT procedures.
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R. Chan, R. Chan, F. Tournoux, F. Tournoux, A. C. Tournoux, A. C. Tournoux, V. Nandigam, V. Nandigam, R. Manzke, R. Manzke, S. Dalal, S. Dalal, J. Solis-Martin, J. Solis-Martin, D. McCarty, D. McCarty, J. N. Ruskin, J. N. Ruskin, M. H. Picard, M. H. Picard, A. E. Weyman, A. E. Weyman, J. P. Singh, J. P. Singh, } "Novel echocardiographic prediction of non-response to cardiac resynchronization therapy", Proc. SPIE 7262, Medical Imaging 2009: Biomedical Applications in Molecular, Structural, and Functional Imaging, 726229 (6 March 2009); doi: 10.1117/12.811875; https://doi.org/10.1117/12.811875
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