Role of speckle tracking echocardiography in predicting Cardiac Resynchronization Therapy response

ABSTRACT

• : Cardiac resynchronization therapy (CRT) is a well-established treatment in selected patients with drug-refractory heart failure. In order to improve the response rate of patients treated with CRT, imaging can provide information on mechanical dyssynchrony, viability, and cardiac venous anatomy. Two-dimensional speckle tracking imaging is a new echocardiographic method could be useful in assessing dyssynchrony and regional contractility.

Aim of the work: The aim of the present study was to evaluate the ability of longitudinal strain and strain rate imaging by two-dimensional speckle tracking to predict echocardiographic response for CRT.

Subjects and Methods: We studied 28 consecutive CRT patients with class II-IV heart failure, ejection fraction (EF) ≤35%, with LBBB and QRS width ≥120 ms or non LBBB with QRS width ≥150 ms. whereas in addition to standard clinical and echocardiographic assessment  baseline dyssynchrony was evaluated by speckle tracking longitudinal strain. 

• Our patients were divided into responders (19 patients) and  non-responders(8 patients) according  to reduction of left ventricular end systolic volume( LVESV) by ≥15% after 3 months of pacing .There was statistically significant difference between responders and non-responders for their baseline speckle-tracking (P value <0.001).  By using receiver operating characteristics (ROC) curve longitudinal dyssynchrony predicted CRT as Basal septal-Basal lateral with cutoff  value 135 ms and Mid septal-Mid lateral with cutoff value 125 ms showed high sensitivity and specificity 95% and 100 % respectively for both  but Basal anterior –Basal inferior  with cutoff value 135 ms  showed lower sensitivity and specificity 85 % and 87.5 % respectively

Conclusion: The LV dyssynchrony assessed by speckle tracking using longitudinal strain was predictive to CRT response.

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