Left ventricular strain for predicting the response to cardiac resynchronization therapy: two methods for one...

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Imaging

Background:

• Cardiac resynchronization therapy (CRT) aims to improve outcomes in heart failure patients with dyssynchrony.
• Accurate patient selection for CRT is crucial for maximizing treatment efficacy and reverse remodeling.
• Myocardial work and longitudinal strain integrals are emerging quantitative methods for assessing cardiac function and dyssynchrony.

Purpose of the Study:

• To compare the predictive value of myocardial work and integral-derived longitudinal strain for CRT response.
• To evaluate the performance of these methods in both mono-parametric and multiparametric settings.

Main Methods:

• Retrospective analysis of 243 patients undergoing CRT implantation across three European centers.
• Calculation of regional myocardial work and strain integrals from the four-chamber view.
• Assessment of predictive performance using receiver operating characteristic (ROC) curves and area under the curve (AUC) for 6-month reverse remodeling.

Main Results:

• Myocardial work demonstrated a significantly higher AUC (0.73) than strain integrals (AUC=0.63) in mono-parametric prediction of CRT response.
• In multiparametric analysis, combining myocardial work and strain integrals yielded comparable AUCs (0.77 and 0.72) without significant differences.
• ROC curve analysis confirmed the superior performance of myocardial work as a single predictor.

Conclusions:

• Myocardial work is a more effective standalone parameter for predicting CRT response.
• The combination of myocardial work and strain integrals shows similar efficacy to individual methods in multiparametric or machine-learning models.
• These findings support the utility of myocardial work in optimizing patient selection for CRT.