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  • Title: Tissue synchronisation imaging accurately measures left ventricular dyssynchrony and predicts response to cardiac resynchronisation therapy.
    Author: Van de Veire NR, Bleeker GB, De Sutter J, Ypenburg C, Holman ER, van der Wall EE, Schalij MJ, Bax JJ.
    Journal: Heart; 2007 Sep; 93(9):1034-9. PubMed ID: 17309912.
    Abstract:
    BACKGROUND: Tissue synchronisation imaging (TSI) is a new technique to assess left ventricular (LV) dyssynchrony. OBJECTIVES: The value of using TSI to automatically assess LV dyssynchrony compared with manual assessment of LV dyssynchrony from colour-coded tissue Doppler imaging (TDI), and to evaluate the value of TSI to predict response to cardiac resynchronisation therapy (CRT). METHODS: 60 symptomatic patients with heart failure with depressed LV ejection fraction (LVEF) and QRS >120 ms were evaluated clinically and echocardiographically at baseline and after 6 months of CRT. LV dyssynchrony was measured manually using velocity tracings from the colour-coded TDI and automatically using TSI. LV volumes and LVEF were assessed from two-dimensional echocardiography. Clinical responders had to exhibit an improvement in New York Heart Association functional class by > or =1 score and an improvement by > or =25% in 6 min walking distance after 6 months. Reverse LV remodelling was defined as a reduction of > or =15% LV end-systolic volume. RESULTS: An excellent correlation was observed between LV dyssynchrony measured manually and automatically derived by TSI (r = 0.95, p<0.001). 34 patients showed clinical response after 6 months of CRT and 32 patients showed reverse remodelling. Baseline characteristics were comparable between responders and non-responders, except for more extensive LV dyssynchrony in the responders: 78 (26) vs 29 (29) ms (p<0.001) as assessed manually, and 79 (29) vs 28 (27) ms (p<0.001) as assessed with TSI. Using a cut-off value of 65 ms to define extensive LV dyssynchrony, TSI had a sensitivity of 81% with a specificity of 89% to predict reverse LV remodelling. CONCLUSION: TSI allows automatic and reliable assessment of LV dyssynchrony and predicts reverse LV remodelling after CRT.
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