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Year: 2012 Volume: 5 Issue: 3

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Year: 2012 Volume: 5 Issue: 1

Mechanistic evaluation of echocardiographic dyssynchrony indices: patient data combined with multiscale computer simulations.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Lumens, Joost Leenders, Geert E. Cramer, Maarten J. De Boeck, Bart W. L. Doevendans, Pieter A. Prinzen, Frits W. Delhaas, Tammo
Description	Country affiliation: Netherlands Author Affiliation: Lumens J ( Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands. joost.lumens@maastrichtuniversity.nl)
Abstract	BACKGROUND: The power of echocardiographic dyssynchrony indices to predict response to cardiac resynchronization therapy (CRT) appears to vary between indices and between studies. We investigated whether the variability of predictive power between the dyssynchrony indices can be explained by differences in their operational definitions. METHODS AND RESULTS: In 132 CRT-candidates (left ventricular [LV] ejection fraction, 19 ± 6%; QRS width, 170 ± 22 ms), 4 mechanical dyssynchrony indices (septal systolic rebound stretch [SRSsept], interventricular mechanical dyssynchrony [IVMD], septal-to-lateral peak shortening delay [Strain-SL], and septal-to-posterior wall motion delay [SPWMD]) were quantified at baseline. CRT response was quantified as 6-month percent change of LV end-systolic volume. Multiscale computer simulations of cardiac mechanics and hemodynamics were used to assess the relationships between dyssynchrony indices and CRT response within wide ranges of dyssynchrony of LV activation and reduced contractility. In patients, SRSsept showed best correlation with CRT response followed by IVMD, Strain-SL, and SPWMD (R=-0.56, -0.50, -0.48, and -0.39, respectively; all P<0.01). In patients and simulations, SRSsept and IVMD showed a continuous linear relationship with CRT response, whereas Strain-SL and SPWMD showed discontinuous relationships characterized by data clusters. Model simulations revealed that this data clustering originated from the complex multipeak pattern of septal strain and motion. In patients and simulations with (simulated) LV scar, SRSsept and IVMD retained their linear relationship with CRT response, whereas Strain-SL and SPWMD did not. CONCLUSIONS: The power to predict CRT response differs between indices of mechanical dyssynchrony. SRSsept and IVMD better represent LV dyssynchrony amenable to CRT and better predict CRT response than the indices assessing time-to-peak deformation or motion.
File Format	HTM / HTML
ISSN	19419651
e-ISSN	19420080
Journal	Circulation: Cardiovascular Imaging
Issue Number	4
Volume Number	5
Language	English
Publisher	American Heart Association
Publisher Date	2012-07-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Diagnostic Imaging Discipline Cardiology Cardiac Resynchronization Therapy Computer Simulation Echocardiography Heart Failure Therapy Models, Cardiovascular Biomechanical Phenomena Physiopathology Hemodynamics Linear Models Myocardial Contraction Physiology Predictive Value Of Tests Prospective Studies Thoracic Surgery, Video-assisted Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Radiology, Nuclear Medicine and Imaging Cardiology and Cardiovascular Medicine

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