Abstract 10861: Real Time 3-Dimensional Echocardiography and Tri-Plane Tissue Synchronization Imaging are Complementary Modalities to Predict Significant Reverse Remodeling after Cardiac Resynchronization Therapy
Objective: Real time 3-dimensional echocardiography (RT3DE) and triplane Tissue Synchronization Imaging (TSI) individually permit assessment of left ventricular dyssynchrony (LVdyss) by providing information on temporal occurrence of LV systolic mechanical events. Whether an approach using both modalities better predicts significant reverse remodeling after CRT remains unknown.
Methods: In a cohort of 166 patients (mean age 66±9 years, 78%; male) selected for CRT according to current guidelines, LVdyss was assessed using RT3DE and triplane TSI. LVdyss was defined by the presence of a systolic dyssynchrony index (SDI) ≥6.4%; when assessed with RT3DE and ≥33 ms when assessed with triplane TSI. CRT response was defined by the presence of ≥15%; reduction in LV end-systolic volume at 6 months follow-up.
Results: Mean SDI was 8.44±4.06%; and mean triplane TSI LVdyss was 48±22ms. In 90%; of patients with both LVdyss criteria exhibited significant LV reverse remodeling at 6 months whereas 97%; of patients with none of the LV dyssynchrony criteria did not show CRT response (P<0.001). Age, gender, ischemic etiology of heart failure, baseline left ventricular ejection fraction and New York Heart Association functional class were the clinical variables included in a logistic regression model, along with both LVdyss modalities. Importantly, SDI and tri-plane TSI LVdyss were both independent predictors of significant LV reverse remodeling at 6 months follow-up (P<0.001 for each modality respectively) along with ischemic etiology of heart failure (P=0.018). Finally, the assessment of LVdyss with both modalities showed incremental value for prediction of significant LV reverse remodeling over its assessment with only one modality (Chi-Square change from 63 to 89; P<0.001).
Conclusion: The combined use of RT3DE and triplane TSI to assess LVdyss before CRT implantation permits better prediction of LV reverse remodeling at 6 months follow-up.
- © 2010 by American Heart Association, Inc.