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Regional Strain Pattern Index-A Novel Technique to Predict CRT Response
Michał Orszulak1, Artur Filipecki1, Wojciech Wróbel1
1First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, ul. Ziolowa 45/47, 40-635 Katowice, Poland.
Insights
A new index, the Regional Strain Pattern Index (RSPI), shows promise in predicting heart failure (HF) patient response to cardiac resynchronization therapy (CRT). Higher RSPI scores indicate a greater likelihood of positive outcomes from CRT.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Cardiac resynchronization therapy (CRT) is a treatment for heart failure (HF), but about 30% of patients do not respond.
- Predicting CRT response is crucial for optimizing patient outcomes.
Purpose of the Study:
- To introduce and evaluate a novel index, the Regional Strain Pattern Index (RSPI), for predicting CRT response in HF patients.
- To assess the correlation between RSPI and treatment outcomes.
Main Methods:
- Echocardiography was performed on 49 HF patients before and after CRT implantation.
- The RSPI was calculated from 12 myocardial segments across three apical views, assessing specific contraction and prestretching patterns.
- Dyssynchrony was evaluated using RSPI and strain patterns at baseline.
Main Results:
- Patients who responded to CRT had significantly higher mean RSPI values (5.86 ± 2.9) compared to non-responders (4.08 ± 2.4).
- An RSPI value of 7 or higher was identified as a strong predictor of a favorable CRT effect (OR: 12; p = 0.004).
Conclusions:
- The Regional Strain Pattern Index (RSPI) shows potential as a valuable tool for predicting positive outcomes in heart failure patients undergoing CRT.
- RSPI may aid clinicians in patient selection and management for CRT.
Background:
Cardiac resynchronization therapy (CRT) improves outcome in patients with heart failure (HF) however approximately 30% of patients still remain non-responsive. We propose a novel index-Regional Strain Pattern Index (RSPI)-to prospectively evaluate response to CRT.
Methods:
Echocardiography was performed in 49 patients with HF (66.5 ± 10 years, LVEF 24.9 ± 6.4%, QRS width 173.1 ± 19.1 ms) two times: before CRT implantation and 15 ± 7 months after. At baseline, dyssynchrony was assessed including RSPI and strain pattern. RSPI was calculated from all three apical views across 12 segments as the sum of dyssynchronous components. From every apical view, presence of four components were assessed: (1) contraction of the early-activated wall; (2) prestretching of the late activated wall; (3) contraction of the early-activated wall in the first 70% of the systolic ejection phase; (4) peak contraction of the late-activated wall after aortic valve closure. Each component scored 1 point, thus the maximum was 12 points.
Results:
Responders reached higher mean RSPI values than non-responders (5.86 ± 2.9 vs. 4.08 ± 2.4; p = 0.044). In logistic regression analysis value of RSPI ≥ 7 points was a predictor of favorable CRT effect (OR: 12; 95% CI = 1.33-108.17; p = 0.004).
Conclusions:
RSPI could be a valuable predictor of positive outcome in HF patients treated with CRT.
