Cardiac dyssynchrony analysis using circumferential versus longitudinal strain

Implications for assessing cardiac resynchronization

Robert H. Helm, Christophe Leclercq, Owen P. Paris, Cengizhan Ozturk, Elliot McVeigh, Albert C. Lardo, David A Kass

Research output: Contribution to journalArticle

Abstract

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 (εll). 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; εcc). Methods and Results-Both εll and εcc 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 εcc-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, εll-based indexes indicated resynchronization in diastole but much less in systole and had a lower dynamic range and higher intrasubject variance. 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 εll-based analyses and support further efforts to develop noninvasive synchrony measures based on circumferential deformation.

Original languageEnglish (US)
Pages (from-to)2760-2767
Number of pages8
JournalCirculation
Volume111
Issue number21
DOIs
StatePublished - May 31 2005

Fingerprint

Cardiac Resynchronization Therapy
Heart Failure
Diastole
Systole
Heart Ventricles
Analysis of Variance
Dogs
Muscles

Keywords

  • Bundle-branch block
  • Heart failure
  • Pacing
  • Resynchronization therapy

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Cardiac dyssynchrony analysis using circumferential versus longitudinal strain : Implications for assessing cardiac resynchronization. / Helm, Robert H.; Leclercq, Christophe; Paris, Owen P.; Ozturk, Cengizhan; McVeigh, Elliot; Lardo, Albert C.; Kass, David A.

In: Circulation, Vol. 111, No. 21, 31.05.2005, p. 2760-2767.

Research output: Contribution to journalArticle

Helm, Robert H. ; Leclercq, Christophe ; Paris, Owen P. ; Ozturk, Cengizhan ; McVeigh, Elliot ; Lardo, Albert C. ; Kass, David A. / Cardiac dyssynchrony analysis using circumferential versus longitudinal strain : Implications for assessing cardiac resynchronization. In: Circulation. 2005 ; Vol. 111, No. 21. pp. 2760-2767.
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abstract = "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 (εll). 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; εcc). Methods and Results-Both εll and εcc 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 εcc-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, εll-based indexes indicated resynchronization in diastole but much less in systole and had a lower dynamic range and higher intrasubject variance. 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 εll-based analyses and support further efforts to develop noninvasive synchrony measures based on circumferential deformation.",
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