Echocardiography for Prediction of 6-month and Late Response to Cardiac Resynchronization Therapy: Implementation of Stress Echocardiography and Comparative Assessment Along with Widely Used Dyssynchrony Indices

Overview

Journal Int J Cardiovasc Imaging

Publisher Springer

Specialty Radiology

Date 2019 Jan 10

PMID 30623352

Citations 1

Authors

Emmanouil Poulidakis

Constantina Aggeli

Skevos Sideris

Eliza Sfendouraki

Iosif Koutagiar

Andreas Katsaros

Evangelos Giannoulis

Markos Koukos

Eleni Margioula

Stavroula Lagoudakou

Kostas Gatzoulis

Polychronis Dilaveris

Ioannis Kallikazaros

Stavroula Couloheri

Christodoulos Stefanadis

Dimitrios Tousoulis

Affiliations

Soon will be listed here.

Abstract

Non-response cardiac resynchronization therapy (CRT) remains an issue, despite the refinement of selection criteria. The purpose of this study was to investigate the role of stress echocardiography along with dyssynchrony parameters for identification of CRT responders or late responders. 106 symptomatic heart failure patients were examined before, 6 months and 2-4 years after CRT implementation. Inotropic contractile reserve (ICR) and inferolateral (IL) wall viability were studied by stress echocardiography. Dyssynchrony was assessed by: (1) Septal to posterior wall motion delay (SPWMD) by m-mode. (2) Septal to lateral wall delay (SLD) by TDI. (3) Interventricular mechanical delay (IVMD) by pulsed wave Doppler for (4) difference in time to peak circumferential strain (TmaxCS) by speckle tracking. (5) Apical rocking (ApR) and septal flash (SF) by visual assessment. At 6 months there were 54 responders, with 12 additional late responders. TmaxCS had the greatest predictive value with an area under curve (AUC) of 0.835, followed by the presence of both ICR and viability of IL wall (AUC 0.799), m-mode (AUC = 0.775) and presence of either ApR or SF (AUC = 0.772). Predictive ability of ApR and of ICR is augmented if late responders are also included. Performance of dyssynchrony parameters is enhanced, in patients with both ICR and IL wall viability. Stress echocardiography and dyssynchrony parameters are simple and reliable predictors of 6-month and late CRT response. A stepwise approach with an initial assessment of ICR and viability and, if positive, further dyssynchrony analysis, could assist decision making.

Citing Articles

The Utility of Low-Dose-Dobutamine Stress Echocardiography in Patients with Heart Failure with Reduced Ejection Fraction: An Update.

Tsigkriki L, Kleitsioti P, Dimitriadis F, Sidiropoulos G, Alkagiet S, Efstratiou D Diagnostics (Basel). 2023; 13(18).

PMID: 37761286 PMC: 10527914. DOI: 10.3390/diagnostics13182920.

References

. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002; 166(1):111-7. DOI: 10.1164/ajrccm.166.1.at1102. View

Pitzalis M, Iacoviello M, Romito R, Massari F, Rizzon B, Luzzi G . Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony. J Am Coll Cardiol. 2002; 40(9):1615-22. DOI: 10.1016/s0735-1097(02)02337-9. View

Yu C, Fung W, Lin H, Zhang Q, Sanderson J, Lau C . Predictors of left ventricular reverse remodeling after cardiac resynchronization therapy for heart failure secondary to idiopathic dilated or ischemic cardiomyopathy. Am J Cardiol. 2003; 91(6):684-8. DOI: 10.1016/s0002-9149(02)03404-5. View

Bax J, Bleeker G, Marwick T, Molhoek S, Boersma E, Steendijk P . Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. J Am Coll Cardiol. 2004; 44(9):1834-40. DOI: 10.1016/j.jacc.2004.08.016. View

Pellikka P, Nagueh S, Elhendy A, Kuehl C, Sawada S . American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography. J Am Soc Echocardiogr. 2007; 20(9):1021-41. DOI: 10.1016/j.echo.2007.07.003. View

Ypenburg C, Sieders A, Bleeker G, Holman E, van der Wall E, Schalij M . Myocardial contractile reserve predicts improvement in left ventricular function after cardiac resynchronization therapy. Am Heart J. 2007; 154(6):1160-5. DOI: 10.1016/j.ahj.2007.07.035. View

Gorcsan 3rd J, Abraham T, Agler D, Bax J, Derumeaux G, Grimm R . Echocardiography for cardiac resynchronization therapy: recommendations for performance and reporting--a report from the American Society of Echocardiography Dyssynchrony Writing Group endorsed by the Heart Rhythm Society. J Am Soc Echocardiogr. 2008; 21(3):191-213. DOI: 10.1016/j.echo.2008.01.003. View

Chung E, Leon A, Tavazzi L, Sun J, Nihoyannopoulos P, Merlino J . Results of the Predictors of Response to CRT (PROSPECT) trial. Circulation. 2008; 117(20):2608-16. DOI: 10.1161/CIRCULATIONAHA.107.743120. View

Voigt J, Schneider T, Korder S, Szulik M, Gurel E, Daniel W . Apical transverse motion as surrogate parameter to determine regional left ventricular function inhomogeneities: a new, integrative approach to left ventricular asynchrony assessment. Eur Heart J. 2009; 30(8):959-68. DOI: 10.1093/eurheartj/ehp062. View

10.

Lancellotti P, Senechal M, Moonen M, Donal E, Magne J, Nellessen E . Myocardial contractile reserve during exercise predicts left ventricular reverse remodelling after cardiac resynchronization therapy. Eur J Echocardiogr. 2009; 10(5):663-8. DOI: 10.1093/ejechocard/jep033. View

11.

Olsen N, Mogelvang R, Jons C, Fritz-Hansen T, Sogaard P . Predicting response to cardiac resynchronization therapy with cross-correlation analysis of myocardial systolic acceleration: a new approach to echocardiographic dyssynchrony evaluation. J Am Soc Echocardiogr. 2009; 22(6):657-64. DOI: 10.1016/j.echo.2009.03.017. View

12.

Bertola B, Rondano E, Sulis M, Sarasso G, Piccinino C, Marti G . Cardiac dyssynchrony quantitated by time-to-peak or temporal uniformity of strain at longitudinal, circumferential, and radial level: implications for resynchronization therapy. J Am Soc Echocardiogr. 2009; 22(6):665-71. DOI: 10.1016/j.echo.2009.03.010. View

13.

Moss A, Hall W, Cannom D, Klein H, Brown M, Daubert J . Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009; 361(14):1329-38. DOI: 10.1056/NEJMoa0906431. View

14.

Fornwalt B, Sprague W, BeDell P, Suever J, Gerritse B, Merlino J . Agreement is poor among current criteria used to define response to cardiac resynchronization therapy. Circulation. 2010; 121(18):1985-91. PMC: 2882855. DOI: 10.1161/CIRCULATIONAHA.109.910778. View

15.

Tanaka H, Nesser H, Buck T, Oyenuga O, Janosi R, Winter S . Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy: results of the Speckle Tracking and Resynchronization (STAR) study. Eur Heart J. 2010; 31(14):1690-700. PMC: 2903716. DOI: 10.1093/eurheartj/ehq213. View

16.

Szulik M, Tillekaerts M, Vangeel V, Ganame J, Willems R, Lenarczyk R . Assessment of apical rocking: a new, integrative approach for selection of candidates for cardiac resynchronization therapy. Eur J Echocardiogr. 2010; 11(10):863-9. DOI: 10.1093/ejechocard/jeq081. View

17.

Miyazaki C, Redfield M, Powell B, Lin G, Herges R, Hodge D . Dyssynchrony indices to predict response to cardiac resynchronization therapy: a comprehensive prospective single-center study. Circ Heart Fail. 2010; 3(5):565-73. DOI: 10.1161/CIRCHEARTFAILURE.108.848085. View

18.

Dickstein K, Vardas P, Auricchio A, Daubert J, Linde C, McMurray J . 2010 Focused Update of ESC Guidelines on device therapy in heart failure: an update of the 2008 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure and the 2007 ESC Guidelines for cardiac and resynchronization therapy..... Europace. 2010; 12(11):1526-36. DOI: 10.1093/europace/euq392. View

19.

Auricchio A, Prinzen F . Non-responders to cardiac resynchronization therapy: the magnitude of the problem and the issues. Circ J. 2011; 75(3):521-7. DOI: 10.1253/circj.cj-10-1268. View

20.

Pouleur A, Knappe D, Shah A, Uno H, Bourgoun M, Foster E . Relationship between improvement in left ventricular dyssynchrony and contractile function and clinical outcome with cardiac resynchronization therapy: the MADIT-CRT trial. Eur Heart J. 2011; 32(14):1720-9. DOI: 10.1093/eurheartj/ehr185. View