Strain imaging to predict response to cardiac resynchronization therapy: a systematic comparison of strain parameters using multiple imaging techniques
Zweerink, Alwin; van Everdingen, Wouter M.; Nijveldt, Robin; Salden, Odette A.E.; Meine, Mathias; Maass, Alexander H.; Vernooy, Kevin; de Lange, Frederik J.; Vos, Marc A.; Croisille, Pierre; Clarysse, Patrick; Geelhoed, Bastiaan; Rienstra, Michiel; van Gelder, Isabelle C.; van Rossum, Albert C.; Cramer, Maarten J.; Allaart, Cornelis P.
(2018) ESC Heart Failure, volume 5, issue 6, pp. 1130 - 1140
(Article)
Abstract
Aims: Various strain parameters and multiple imaging techniques are presently available including cardiovascular magnetic resonance (CMR) tagging (CMR-TAG), CMR feature tracking (CMR-FT), and speckle tracking echocardiography (STE). This study aims to compare predictive performance of different strain parameters and evaluate results per imaging technique to predict cardiac resynchronization therapy (CRT)
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response. Methods and results: Twenty-seven patients were prospectively enrolled and underwent CMR and echocardiographic examination before CRT implantation. Strain analysis was performed in circumferential (CMR-TAG, CMR-FT, and STE-circ) and longitudinal (STE-long) orientations. Regional strain values, parameters of dyssynchrony, and discoordination were calculated. After 12 months, CRT response was measured by the echocardiographic change in left ventricular (LV) end-systolic volume (LVESV). Twenty-six patients completed follow-up; mean LVESV change was −29 ± 27% with 17 (65%) patients showing ≥15% LVESV reduction. Measures of dyssynchrony (SD-TTPLV) and discoordination (ISFLV) were strongly related to CRT response when using CMR-TAG (R2 0.61 and R2 0.57, respectively), but showed poor correlations for CMR-FT and STE (all R2 ≤ 0.32). In contrast, the end-systolic septal strain (ESSsep) parameter showed a consistent high correlation with LVESV change for all techniques (CMR-TAG R2 0.60; CMR-FT R2 0.50; STE-circ R2 0.43; and STE-long R2 0.43). After adjustment for QRS duration and QRS morphology, ESSsep remained an independent predictor of response per technique. Conclusions: End-systolic septal strain was the only parameter with a consistent good relation to reverse remodelling after CRT, irrespective of assessment technique. In clinical practice, this measure can be obtained by any available strain imaging technique and provides predictive value on top of current guideline criteria.
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Keywords: Cardiac resynchronization therapy (CRT), Cardiovascular magnetic resonance (CMR), Feature tracking (CMR-FT), Myocardial strain analysis, Myocardial tagging (CMR-TAG), Speckle tracking echocardiography (STE), Cardiology and Cardiovascular Medicine
ISSN: 2213-1779
Publisher: Elsevier BV
Note: Funding Information: K.V. received consultancy fee from Medtronic, research grants from Medtronic, and speaker fees from St. Jude Medical. A.H.M. received lecture fees from Medtronic and LivaNova. M.A.V. received funding from CTMM COHFAR, CVON Predict, EU TrigTreat, EU CERT-ICD, and GiLead to perform (pre)clinical studies. All remaining authors declare that they have no conflict of interests. Funding Information: This research was funded within the framework of CTMM, the Centre for Translational Molecular Medicine (www. ctmm.nl), project COHFAR (grant 01C-203), and supported by the Dutch Heart Foundation. Publisher Copyright: © 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.
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