Poor agreement of echographic measures of ventricular dyssynchrony

Area of Science:

• Cardiology
• Medical Imaging
• Biomedical Engineering

Background:

• Echocardiography is crucial for patient selection in cardiac resynchronization therapy (CRT).
• Standard echocardiography and tissue Doppler imaging (TDI) are common methods for assessing cardiac dyssynchrony.
• The concordance between these echocardiographic techniques for dyssynchrony evaluation is not well-established.

Purpose of the Study:

• To compare the agreement between standard echocardiography and pulsed-wave TDI in diagnosing inter- and intraventricular dyssynchrony.
• To assess the reliability of different echocardiographic parameters for dyssynchrony evaluation in heart failure patients.

Main Methods:

• 44 patients with left ventricular ejection fraction ≤0.35 were studied.
• Dyssynchrony was assessed using standard echocardiography (interventricular mechanical delay, posterior wall motion) and pulsed-wave TDI (delay to onset Sm(o), delay to peak Sm(p)).
• A control group of 40 healthy subjects was used to establish cutoff values.

Main Results:

• Agreement between standard echocardiography and TDI for dyssynchrony was poor (kappa < 0.33).
• Intraventricular dyssynchrony was detected in 34% of patients by LV dispersion of Sm(o) > 20 ms, but not by posterior wall motion.
• TDI parameters using Sm(p) demonstrated high variability and poor reproducibility.

Conclusions:

• Standard echocardiography and TDI demonstrate poor agreement in diagnosing cardiac dyssynchrony.
• These echocardiographic techniques are not interchangeable for dyssynchrony assessment in CRT candidates.
• Further research is needed to refine and validate methods for accurate dyssynchrony evaluation.