A comparison between radial strain evaluation by speckle-tracking echocardiography and cardiac magnetic resonance imaging, for assessment of suitable segments for left ventricular lead placement in cardiac resynchronization therapy.
نویسندگان
چکیده
AIMS A cut-off of 9.8% maximum speckle-tracking radial strain in the segment with the latest mechanical delay has been proposed as predictive for selecting the best left ventricular lead placement for positive response on cardiac resynchronization therapy (CRT). However, pacing transmural scar should be avoided, and the purpose of this study was to evaluate the ability of echocardiographic radial strain to predict the presence of scar in the left ventricle segments. METHODS AND RESULTS A total of 404 left ventricular segments were analysed, from 34 patients eligible for CRT. Pre-operative cardiac magnetic resonance (CMR) and echocardiography were performed, and maximal strain values from echocardiography speckle tracking were compared with CMR data. Hypokinesia and strain values showed a strong correlation (P < 0.001). Even though segments with CMR-verified scar had lower strain values than segments without scar (14.8 ± 7 vs. 16.0 ± 10), the predictive value of the proposed 9.8% cut-off was low (sensitivity 33% and specificity 72%). Scar burden was higher in ischaemic patients (13.5 vs. 5.3% P = 0.0001). Relative difference in strain values (target segment strain compared with the average strain value of the adjacent segments) was higher if there was transmural scar in the target segment as compared with a hypokinetic but viable target segment (87 vs. 38% difference, P = 0.03). CONCLUSION Speckle tracking radial strain should ideally be complemented by CMR for accurate assessment of viability, especially for patients with ischaemic aetiology of heart failure where transmural scar is more common. Comparison of strain values with the adjacent segments may be helpful for assessing viability.
منابع مشابه
Combined preoperative information using a bullseye plot from speckle tracking echocardiography, cardiac CT scan, and MRI scan: targeted left ventricular lead implantation in patients receiving cardiac resynchronization therapy.
AIMS To evaluate the feasibility and incremental value of using an integrated bullseye model for presenting data from cardiac computed tomography (CT) and magnetic resonance imaging (MRI) in combination with echocardiography evaluation of segmental mechanical delay for guiding optimal left ventricular lead placement in cardiac resynchronization therapy (CRT). METHODS AND RESULTS Thirty-nine p...
متن کاملFeature tracking measurement of dyssynchrony from cardiovascular magnetic resonance cine acquisitions: comparison with echocardiographic speckle tracking
BACKGROUND Analysis of left ventricular (LV) mechanical dyssynchrony may provide incremental prognostic information regarding cardiac resynchronization therapy (CRT) response in addition to QRS width alone. Our objective was to quantify LV dyssynchrony using feature tracking post processing of routine cardiovascular magnetic resonance (CMR) cine acquisitions (FT-CMR) in comparison to speckle tr...
متن کاملImaging Relative Merits of Left Ventricular Dyssynchrony, Left Ventricular Lead Position, and Myocardial Scar to Predict Long-Term Survival of Ischemic Heart Failure Patients Undergoing Cardiac Resynchronization Therapy
Background—The relative merits of left ventricular (LV) dyssynchrony, LV lead position, and myocardial scar to predict long-term outcome after cardiac resynchronization therapy remain unknown and were evaluated in the present study. Methods and Results—In 397 ischemic heart failure patients, 2-dimensional speckle tracking imaging was performed, with comprehensive assessment of LV radial dyssync...
متن کاملTargeted left ventricular lead placement to guide cardiac resynchronization therapy: the TARGET study: a randomized, controlled trial.
OBJECTIVES This study sought to assess the impact of targeted left ventricular (LV) lead placement on outcomes of cardiac resynchronization therapy (CRT). BACKGROUND Placement of the LV lead to the latest sites of contraction and away from the scar confers the best response to CRT. We conducted a randomized, controlled trial to compare a targeted approach to LV lead placement with usual care....
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
دوره 16 12 شماره
صفحات -
تاریخ انتشار 2014