Pilot study using 3D-longitudinal strain computation in a multi-parametric approach for best selecting responders to...

Area of Science:

• Cardiology
• Medical Imaging
• Biomedical Engineering

Background:

• Previous attempts to predict cardiac resynchronization therapy (CRT) response using echocardiography-derived indices have largely failed.
• Accurate patient selection remains a challenge for optimizing CRT outcomes.

Purpose of the Study:

• To evaluate novel homemade software for automatic quantification of 3D regional longitudinal strain curves.
• To assess the potential of this software in predicting CRT response in heart failure patients.

Main Methods:

• Prospective study of 48 heart failure patients undergoing CRT implantation.
• Analysis of 3D longitudinal strain curves using custom algorithms to measure integrals (I L,peak) for 17 left ventricular (LV) segments.
• Response defined as ≥15% decrease in LV end-systolic volume at 6 months.

Main Results:

• The standard deviation of longitudinal strain peak (SDI L,peak) was significantly higher in CRT responders (1.18% s⁻¹) compared to non-responders (0.83% s⁻¹).
• An optimal cut-off value of 1.037% s⁻¹ for SDI L,peak was identified to predict CRT response.
• Higher SDI L,peak was observed in responders even in patients without septal flash.

Conclusions:

• The developed automatic software effectively analyzes 3D longitudinal strain curves, overcoming limitations of previous imaging techniques for assessing dyssynchrony.
• This tool shows potential for improved patient selection for CRT.
• Further validation in larger patient cohorts is warranted.