Optimization of pulsed wave tissue Doppler to predict left ventricular reverse remodeling after cardiac resynchronization therapy

OBJECTIVE: The optimal use of pulsed wave Doppler tissue imaging (DTI) in predicting left ventricular (LV) reverse remodeling after cardiac resynchronization therapy (CRT) was investigated. METHODS: DTI was performed in 69 patients before and 3 months after CRT. Echocardiographic reverse remodeling was observed in 38 patients. LV dyssynchrony was measured with the time to onset or peak systolic velocity in 2- and 6-basal segment models. RESULTS: The time to onset and either the standard deviation of 6 segments of > 20 ms or a delay of > or = 60 ms between any 2 of 6 segments had a similar predictive accuracy (sensitivity, 97% and 95%, respectively; specificity, 74% and 73%, respectively). The time to peak systolic velocity or evaluating 2 segments was less accurate. CONCLUSIONS: Evaluation of 6 segments is necessary to predict LV reverse remodeling after CRT. The time to onset of systolic velocity is superior to the time to peak velocity

The influence of myocardial scar and dyssynchrony on reverse remodeling in cardiac resynchronization therapy

Aim: The influence of location and extent of transmural scar and its relation with dyssynchrony in cardiac resynchronization therapy (CRT) was investigated as posterolateral scar tissue has been invoked as a cause of non-response to CRT. Methods and results: Fifty-seven patients eligible for CRT were assessed for transmural scar with gadolinium-enhanced MRI and for left ventricular (LV) dyssynchrony with tissue Doppler. After implant, both atrioventricular and interventricular pacing intervals were optimized. LV reverse remodeling was defined as 10% decrease in LV end-systolic volume after 3 months. Sixteen patients had transmural scar in the posterolateral (PL) area (LV lead location), 14 at a remote site (non-PL) and 27 patients had no scar. LV reverse remodeling was observed in respectively 25%, 64% and 89% (P = 0.0001). Univariate analyses showed a relation with LV dyssynchrony (P = 0.004) and with absence of PL scar (P = 0.04) but not with QRS duration and the extent of LV scar tissue. In multivariate analysis, only LV dyssynchrony (OR: 19.62; 95% CI: 2.5–151.9; P = 0.004) independently predicted LV reverse remodeling. Conclusion: In this study LV dyssynchrony remains the most important determinant of response to CRT, even in the presence of posterolateral scar provided atrioventricular and interventricular pacing intervals are optimized

The influence of myocardial scar and dyssynchrony on reverse remodeling in cardiac resynchronization therapy

Aim: The influence of location and extent of transmural scar and its relation with dyssynchrony in cardiac resynchronization therapy (CRT) was investigated as posterolateral scar tissue has been invoked as a cause of non-response to CRT. Methods and results: Fifty-seven patients eligible for CRT were assessed for transmural scar with gadolinium-enhanced MRI and for left ventricular (LV) dyssynchrony with tissue Doppler. After implant, both atrioventricular and interventricular pacing intervals were optimized. LV reverse remodeling was defined as 10% decrease in LV end-systolic volume after 3 months. Sixteen patients had transmural scar in the posterolateral (PL) area (LV lead location), 14 at a remote site (non-PL) and 27 patients had no scar. LV reverse remodeling was observed in respectively 25%, 64% and 89% (P = 0.0001). Univariate analyses showed a relation with LV dyssynchrony (P = 0.004) and with absence of PL scar (P = 0.04) but not with QRS duration and the extent of LV scar tissue. In multivariate analysis, only LV dyssynchrony (OR: 19.62; 95% CI: 2.5–151.9; P = 0.004) independently predicted LV reverse remodeling. Conclusion: In this study LV dyssynchrony remains the most important determinant of response to CRT, even in the presence of posterolateral scar provided atrioventricular and interventricular pacing intervals are optimized