Strain imaging to predict response to cardiac resynchronization therapy: a systematic comparison of strain parameters
Alwin Zweerink1, Wouter M van Everdingen2, Robin Nijveldt1,3
1Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center, Amsterdam, The Netherlands.
ESC Heart Failure
|July 28, 2018
Summary
End-systolic septal strain is a reliable predictor of cardiac resynchronization therapy (CRT) response, regardless of the imaging technique used. This strain parameter offers valuable insights for predicting treatment success in patients undergoing CRT.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Cardiac resynchronization therapy (CRT) response prediction is crucial for patient outcomes.
- Various imaging techniques, including cardiovascular magnetic resonance (CMR) tagging (CMR-TAG), CMR feature tracking (CMR-FT), and speckle tracking echocardiography (STE), offer different strain parameters.
- Current methods for predicting CRT response have limitations.
Purpose of the Study:
- To compare the predictive performance of different strain parameters for CRT response.
- To evaluate the results of strain analysis across various imaging techniques (CMR-TAG, CMR-FT, STE).
- To identify imaging parameters that consistently predict CRT response.
Main Methods:
- Prospective enrollment of 27 patients undergoing CRT implantation.
- Pre-implantation CMR and echocardiographic examinations with strain analysis (circumferential and longitudinal).
- Calculation of regional strain, dyssynchrony, and discoordination parameters; CRT response assessed by left ventricular end-systolic volume (LVESV) change at 12 months.
Main Results:
- Measures of dyssynchrony and discoordination strongly correlated with CRT response using CMR-TAG but poorly with CMR-FT and STE.
- End-systolic septal strain (ESSsep) demonstrated a consistent high correlation with LVESV change across all techniques (CMR-TAG, CMR-FT, STE-circ, STE-long).
- ESSsep remained an independent predictor of CRT response after adjusting for QRS duration and morphology.
Conclusions:
- End-systolic septal strain is the only parameter consistently and accurately predicting reverse remodeling after CRT, irrespective of the imaging technique.
- ESSsep can be obtained using any strain imaging modality and adds predictive value beyond current guideline criteria.
- This finding supports the routine use of ESSsep for predicting CRT response in clinical practice.
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