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Updated: Jun 24, 2026
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
Tissue Doppler velocity is superior to strain imaging in predicting long-term cardiovascular events after cardiac
Q Zhang1, R J van Bommel, J W-H Fung
1Li Ka Shing Institute of Health Sciences, Institute of Vascular Medicine, Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, PR China. cmyu@cuhk.edu.hk
Insights
Systolic dyssynchrony measured by tissue Doppler velocity, not strain, predicts better long-term outcomes after cardiac resynchronisation therapy (CRT). This finding aids in optimizing CRT patient selection for improved cardiovascular event prediction.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Management
Background:
- Cardiac resynchronisation therapy (CRT) is a key treatment for heart failure patients with ventricular dyssynchrony.
- Accurate prediction of long-term outcomes after CRT is crucial for patient management and therapy optimization.
Purpose of the Study:
- To evaluate the predictive capability of systolic dyssynchrony, assessed by tissue Doppler velocity (TDV) versus tissue Doppler strain imaging (TDSI), for long-term outcomes in patients undergoing CRT.
Main Methods:
- A cohort study involving 239 patients who underwent CRT at two university hospitals.
- Baseline echocardiography using tissue Doppler imaging (TDI) assessed maximal delays in systolic velocity (Ts) and strain (T(epsilon)).
- Kaplan-Meier curves and Cox regression analyzed cardiovascular endpoints over a median follow-up of 37 months.
Main Results:
- A maximal delay in Ts of ≥65 ms was associated with significantly lower rates of cardiovascular mortality (19% vs 38%) and other prognostic endpoints.
- Maximal delay in Ts (HR 0.463) and ischemic etiology (HR 2.716) were independent predictors of cardiovascular mortality.
- Maximal delay in T(epsilon) of ≥80 ms did not predict cardiovascular events.
Conclusions:
- Pre-pacing systolic dyssynchrony identified by TDV, specifically maximal delay in Ts, predicts favorable long-term cardiovascular outcomes post-CRT.
- TDSI-derived systolic dyssynchrony (maximal delay in T(epsilon)) did not demonstrate predictive value for long-term cardiovascular events in this cohort.
Objective:
To examine the predictive value of systolic dyssynchrony measured by tissue Doppler velocity versus tissue Doppler strain imaging on long-term outcome after cardiac resynchronisation therapy (CRT).
Design:
Cohort study.
Setting:
Two university hospitals.
Patients:
Two hundred and thirty-nine patients (65 (SD 12) years, 76% males) who underwent CRT.
Interventions:
Baseline echocardiography with tissue Doppler imaging (TDI) and clinical follow-up for 37 (20) months.
Main Outcome Measures:
The time to peak systolic velocity during ejection phase (Ts) and the time to peak systolic strain (T(epsilon)) were assessed for dyssynchrony, that is the maximal delay in Ts and the maximal delay in T(epsilon) among the four left ventricular basal segments. Occurrence of cardiovascular endpoints between patients with and without dyssynchrony was compared by Kaplan-Meier curves, followed by Cox regression analysis for potential predictor(s).
Results:
There were 78 (33%) deaths, with cardiovascular causes in 64 (27%) patients, while 136 (57%) patients were hospitalised for cardiovascular events, including decompensated heart failure in 87 (36%) patients. Patients with the maximal delay in Ts of > or =65 ms showed a lower event rate for cardiovascular mortality (19% vs 38%, logrank chi2 = 7.803, p = 0.005) and other prognostic endpoints. In Cox regression analysis, the maximal delay in Ts (hazard ratio (HR) 0.463, 95% CI 0.270 to 0.792, p = 0.005) and ischaemic aetiology (HR 2.716, 95% CI 1.505 to 4.901, p = 0.001) were independent predictors of cardiovascular mortality. In contrast, the maximal delay in T(epsilon) of > or =80 ms failed to predict any cardiovascular event.
Conclusions:
Echocardiographic evidence of prepacing systolic dyssynchrony measured by TDI velocity, but not TDI strain, predicted lower long-term cardiovascular events after CRT.
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