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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Circumferential 2D-strain imaging for the prediction of long term response to cardiac resynchronization therapy
Fabian Knebel1, Sebastian Schattke, Hansjürgen Bondke
1Universitätsmedizin Berlin, Medical Clinic for Cardiology and Angiology, Charité Campus Mitte, Charitéplatz 1, 10098 Berlin, Germany. fabian.knebel@charite.de
Insights
Cardiac Resynchronization Therapy (CRT) improves heart function. While circumferential 2D-strain shows reduced delays post-CRT, it does not predict long-term patient response better than existing methods.
Area of Science:
- Cardiology
- Medical Imaging
- Heart Failure Management
Background:
- Cardiac Resynchronization Therapy (CRT) improves heart failure outcomes.
- Myocardial asynchrony evaluation traditionally uses longitudinal and radial function.
- Novel imaging techniques are needed to predict CRT response.
Purpose of the Study:
- To evaluate circumferential 2D-strain imaging for predicting long-term CRT response.
- To compare circumferential 2D-strain with longitudinal and radial strain in predicting CRT outcomes.
Main Methods:
- 38 heart failure patients (NYHA II-III, QRS > 120 ms, LVEF < 0.35) underwent CRT.
- Echocardiographic evaluation included circumferential, longitudinal, and radial 2D-strain analysis.
- Patients were followed for a mean of 9.4 months to assess hemodynamic response.
Main Results:
- 47.4% of patients were hemodynamic responders to CRT.
- Responders showed significant reduction in basal circumferential 2D-strain delay (p < 0.001).
- Baseline circumferential 2D-strain delay did not predict long-term CRT response (AUC 0.66).
Conclusions:
- CRT significantly reduces myocardial delays across all dimensions (circumferential, longitudinal, radial).
- Circumferential 2D-strain delays do not offer superior prediction of long-term CRT response compared to other methods.
- Further research may explore combined strain parameters for improved prediction.
Background:
Cardiac Resynchronization Therapy (CRT) leads to hemodynamic and clinical improvement in heart failure patients. The established methods to evaluate myocardial asynchrony analyze longitudinal and radial myocardial function. This study evaluates the new method of circumferential 2D-strain imaging in the prediction of the long-term response to CRT.
Methods And Results:
38 heart failure patients (NYHA II-III, QRS > 120 ms, LVEF < 0.35) received CRT and echocardiographic evaluation with a mean follow-up of 9.4 months. 18 (47.4%) of the patients were hemodynamic responders to long-term CRT. In the responder group, the maximum delay in the circumferential 2D-strain in the basal segments decreased (246 +/- 94 to 123 +/- 92 ms, p < 0.001). In the non-responder group there was no significant change (pre CRT: 195 +/- 86, post CRT 135 +/- 136 ms, p = 0.84). This was paralleled by a reduction of the maximum delay in the radial and longitudinal 2D strain in the basal segments. In ROC analysis, the baseline delay of circumferential 2D strain (AUC 0.66 (+/- 0.14)) does not predict a long-term response to CRT (p = 0.37).
Conclusion:
There is a significant decrease in the circumferential 2D-strain derived delays after CRT, indicating that resynchronization induces improvement in all three dimensions of myocardial contraction. However, the resulting predictive values of 2D strain delays are not superior to longitudinal and radial 2D-strain or TDI delays.
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