Journal Article

Strain Imaging to Predict Response to Cardiac Resynchronization Therapy: A Systematic Comparison of Strain Parameters Using Multiple Imaging Techniques

Maass, Alexander H., Cramer, Maarten J., Salden, Odette A.E., van Everdingen, Wouter M., Nijveldt, Robin, van Rossum, Albert C., Vos, Marc A., Geelhoed, Bastiaan, Rienstra, Michiel, Allaart, Cornelis P., Meine, Mathias, de Lange, Frederik J., Zweerink, Alwin, Clarysse, Patrick, Croisille, Pierre, van Gelder, Isabelle C., Vernooy, Kevin

2018

Overview

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) 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.

• Publisher: Oxford University Press,Wiley,John Wiley and Sons Inc
• Subject: Aged / Bioengineering / Cardiac resynchronization therapy (CRT) / Cardiac Resynchronization Therapy - methods / Cardiovascular magnetic resonance (CMR) / Clinical medicine / Echocardiography - methods / Electrocardiography / Feature tracking (CMR‐FT) / Female / Heart Failure - diagnosis / Heart Failure - physiopathology / Heart Failure - therapy / Humans / Life Sciences / Magnetic Resonance Imaging, Cine - methods / Male / Middle Aged / Morphology / Myocardial Contraction - physiology / Myocardial strain analysis / Myocardial tagging (CMR‐TAG) / Original / Original s / Patients / Predictive Value of Tests / Prospective Studies / Reproducibility of Results / Speckle tracking echocardiography (STE) / Standard deviation / Statistical analysis / Studies / Ventricular Function, Left - physiology