on May 23, 2005
Published online before print May 23, 2005, doi: 10.1161/CIRCULATIONAHA.104.508457
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Submitted on September 21, 2004
From the Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Md (R.H.H., A.C.L., D.A.K.); Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md (A.C.L., D.A.K.); Department of Cardiology, University of Rennes, Rennes, France (C.L.); and Laboratory of Cardiac Energetics, National Institutes of Health, Bethesda, Md (O.P.F., C.O., E.M.). * To whom correspondence should be addressed. E-mail: dkass{at}jhmi.edu.
Background--QRS duration is commonly used to select heart failure patients for cardiac resynchronization therapy (CRT). However, not all patients respond to CRT, and recent data suggest that direct assessments of mechanical dyssynchrony may better predict chronic response. Echo-Doppler methods are being used increasingly, but these principally rely on longitudinal motion ( Methods and Results--Both Conclusions--Dyssynchrony assessed by longitudinal motion is less sensitive to dyssynchrony, follows different time courses than those from circumferential motion, and may manifest CRT benefit during specific cardiac phases depending on pacing mode. These results highlight potential limitations to
Revised on January 21, 2005
Accepted on January 26, 2005
Cardiac Dyssynchrony Analysis Using Circumferential Versus Longitudinal Strain. Implications for Assessing Cardiac Resynchronization
Robert H. Helm MD,
ll). It is unknown whether this analysis yields qualitative and/or quantitative results similar to those based on motion in the predominant muscle-fiber orientation (circumferential; cc).ll and cc strains were calculated throughout the left ventricle from 3D MR-tagged images for the full cardiac cycle in dogs with cardiac failure and a left bundle conduction delay. Dyssynchrony was assessed from both temporal and regional strain variance analysis. CRT implemented by either biventricular (BiV) or left ventricular-only (LV) pacing enhanced systolic function similarly and correlated with improved dyssynchrony based on cc-based metrics. In contrast, longitudinal-based analyses revealed significant resynchronization with BiV but not LV for the overall cycle and correlated poorly with global functional benefit. Furthermore, unlike circumferential analysis, ll-based indexes indicated resynchronization in diastole but much less in systole and had a lower dynamic range and higher intrasubject variance.ll-based analyses and support further efforts to develop noninvasive synchrony measures based on circumferential deformation.
Key words: resynchronization therapy • heart failure • bundle-branch block • pacing
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