Usefulness of Left Ventricular Systolic Dyssynchrony by Real-Time Three-Dimensional Echocardiography to Predict Long-Term Response to Cardiac Resynchronization Therapy

Soliman, Osama I.I.; Geleijnse, Marcel L.; Theuns, Dominic A.M.J.; van Dalen, Bas M.; Vletter, Wim B.; Jordaens, Luc J.; Metawei, Ahmed K.; Al-Amin, Aly M.; ten Cate, Folkert J.

doi:10.1016/j.amjcard.2009.01.372

« Previous Next »American Journal of Cardiology
Volume 103, Issue 11 , Pages 1586-1591, 1 June 2009

Usefulness of Left Ventricular Systolic Dyssynchrony by Real-Time Three-Dimensional Echocardiography to Predict Long-Term Response to Cardiac Resynchronization Therapy

Osama I.I. Soliman, MD, PhD
- Department of Cardiology, The Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Al-Hussein University Hospital, Al-Azhar University, Cairo, Egypt
- Corresponding author: Tel: 31-10-703-5994; fax: 31-10-703-5498
Marcel L. Geleijnse, MD, PhD
- Department of Cardiology, The Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
Dominic A.M.J. Theuns, PhD
- Department of Cardiology, The Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
Bas M. van Dalen, MD
- Department of Cardiology, The Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
Wim B. Vletter, MSc
- Department of Cardiology, The Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
Luc J. Jordaens, MD, PhD
- Department of Cardiology, The Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
Ahmed K. Metawei, MD
- Department of Cardiology, Al-Hussein University Hospital, Al-Azhar University, Cairo, Egypt
Aly M. Al-Amin, MD
- Department of Cardiology, Al-Hussein University Hospital, Al-Azhar University, Cairo, Egypt
Folkert J. ten Cate, MD, PhD
- Department of Cardiology, The Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands

Received 31 December 2008; received in revised form 31 January 2009; accepted 31 January 2009. published online 10 April 2009.

Real-time 3-dimensional echocardiography (RT3DE) allows simultaneous timing of regional volumetric changes as a net result of longitudinal, radial, circumferential left ventricular (LV) contraction, hence LV systolic dyssynchrony. We sought to examine real-time 3-dimensional echocardiographically derived dyssynchrony for prediction of long-term response to cardiac resynchronization therapy (CRT) in a prospective study. Ninety consecutive patients with heart failure (mean age 60 ± 12 years, 73% men, New York Heart Association class III in 97%) underwent clinical and echocardiographic assessments at baseline and at 12 months after CRT including real-time 3-dimensional echocardiographically derived LV systolic dyssynchrony index. The systolic dyssynchrony index (SDI) was defined as the SD of time to minimum systolic volume of the 16 LV segments, expressed in percent RR duration. CRT response was defined as a >15% decrease in LV end-systolic volume on real-time 3-dimensional echocardiogram. After 12 months of CRT, 68 patients (76%) were responders. Feasibility of the SDI was 94%. An SDI >10% predicted CRT response with good sensitivity (96%), specificity (88%), positive likelihood ratio (8), and negative likelihood ratio (0.05). Patients with an SDI >10% had mean change (−21%, −31%, 39% vs −13%, −10%, 10%) in LV end-diastolic volume, LV end-systolic volume, and LV ejection fraction, respectively, compared with baseline versus patients with an SDI <10% (p <0.01). Mean acquisition and analysis duration of single-patient RT3DE was 8 minutes (range 6 to 13). Interobserver variabilities of LV end-systolic volume and SDI were 5% and 11%, respectively. In conclusion, RT3DE provides accurate identification of reverse volumetric LV remodeling after CRT. From these accurate volumetric data, RT3DE provides more intuitive assessment of dyssynchrony and response to CRT as a simple, reproducible, and fast technique. CRT can be individually tailored using RT3DE and seems very effective in patients with heat failure with real-time 3-dimensional echocardiographic evidence of dyssynchrony.