Strain dyssynchrony index determined by three-dimensional speckle area tracking can predict response to cardiac resynchronization therapyReport as inadecuate

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Cardiovascular Ultrasound

, 9:11

First Online: 05 April 2011Received: 07 January 2011Accepted: 05 April 2011


BackgroundWe have previously reported strain dyssynchrony index assessed by two-dimensional speckle tracking strain, and a marker of both dyssynchrony and residual myocardial contractility, can predict response to cardiac resynchronization therapy CRT. A newly developed three-dimensional 3-D speckle tracking system can quantify endocardial area change ratio area strain, which coupled with the factors of both longitudinal and circumferential strain, from all 16 standard left ventricular LV segments using complete 3-D pyramidal datasets. Our objective was to test the hypothesis that strain dyssynchrony index using area tracking ASDI can quantify dyssynchrony and predict response to CRT.

MethodsWe studied 14 heart failure patients with ejection fraction of 27 ± 7% all≤35% and QRS duration of 172 ± 30 ms all≥120 ms who underwent CRT. Echocardiography was performed before and 6-month after CRT. ASDI was calculated as the average difference between peak and end-systolic area strain of LV endocardium obtained from 3-D speckle tracking imaging using 16 segments. Conventional dyssynchrony measures were assessed by interventricular mechanical delay, Yu Index, and two-dimensional radial dyssynchrony by speckle-tracking strain. Response was defined as a ≥15% decrease in LV end-systolic volume 6-month after CRT.

ResultsASDI ≥ 3.8% was the best predictor of response to CRT with a sensitivity of 78%, specificity of 100% and area under the curve AUC of 0.93 p < 0.001. Two-dimensional radial dyssynchrony determined by speckle-tracking strain was also predictive of response to CRT with an AUC of 0.82 p < 0.005. Interestingly, ASDI ≥ 3.8% was associated with the highest incidence of echocardiographic improvement after CRT with a response rate of 100% 7-7, and baseline ASDI correlated with reduction of LV end-systolic volume following CRT r = 0.80, p < 0.001.

ConclusionsASDI can predict responders and LV reverse remodeling following CRT. This novel index using the 3-D speckle tracking system, which shows circumferential and longitudinal LV dyssynchrony and residual endocardial contractility, may thus have clinical significance for CRT patients.

Keywordsheart failure pacemakers echocardiography List of abbreviationsCRTcardiac resynchronization therapy




LVleft ventricular

RVright ventricular

ASDIstrain dyssynchrony index using area tracking

AUCarea under the curve

ESVend-systolic volume

IVMDinterventricular mechanical delay.

Electronic supplementary materialThe online version of this article doi:10.1186-1476-7120-9-11 contains supplementary material, which is available to authorized users.

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Author: Kazuhiro Tatsumi - Hidekazu Tanaka - Takayuki Tsuji - Akihiro Kaneko - Keiko Ryo - Kohei Yamawaki - Alaa MS Omar - Yuko F


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