Recoordination Rather than Resynchronization Predicts Reverse Remodeling after Cardiac Resynchronization Therapy

Wang, Chun-Li; Wu, Chia-Tung; Yeh, Yung-Hsin; Wu, Lung-Sheng; Chang, Chi-Jen; Ho, Wan-Jing; Hsu, Lung-An; Luqman, Nazar; Kuo, Chi-Tai

doi:10.1016/j.echo.2010.03.012

« Previous Next »Journal of the American Society of Echocardiography
Volume 23, Issue 6 , Pages 611-620, June 2010

Recoordination Rather than Resynchronization Predicts Reverse Remodeling after Cardiac Resynchronization Therapy

Chun-Li Wang, MD
- First Division of Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
Chia-Tung Wu, MD
- First Division of Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
Yung-Hsin Yeh, MD
- First Division of Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
Lung-Sheng Wu, MD
- First Division of Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
Chi-Jen Chang, MD
- First Division of Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
Wan-Jing Ho, MD
- First Division of Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
Lung-An Hsu, MD, PhD
- First Division of Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
Nazar Luqman, MD
- Department of Cardiology, RIPAS Hospital, Bander Seri Begawan, Brunei Darussalam
Chi-Tai Kuo, MD
- First Division of Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Reprint requests: Chi-Tai Kuo, MD, First Division of Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, 5, Fushin Street, Kweishan Hsiang, Taoyuan, Taiwan.

published online 26 April 2010.

Background

Mechanical discoordination as studied by magnetic resonance imaging has been shown to be a better predictor of left ventricular (LV) reverse remodeling after cardiac resynchronization therapy (CRT) compared with mechanical dyssynchrony.

Materials and Methods

This study assessed the value of acute recoordination derived from speckle-tracking echocardiography for predicting response to CRT compared with acute resynchronization. Thirty patients with heart failure scheduled for CRT were studied at baseline, immediately after CRT, and after 6 months of CRT. Acute recoordination after CRT was indexed by an acute reduction in radial discoordination index (RDI), defined as the ratio of average myocardial thinning to thickening during the ejection phase.

Results

CRT responders were defined as those patients whose LV end-systolic volume decreased by ≥ 15% at the 6-month follow-up. Immediately after CRT, the responders (n = 18) demonstrated a significant reduction in RDI (P < .001), which was sustained at the 6-month follow-up (P < .001). The nonresponders, however, did not show a significant change in RDI after CRT. LV reverse remodeling at the 6-month follow-up was significantly correlated with acute recoordination (r = 0.75, P < .001) but weakly correlated with acute resynchronization (r = 0.43; P = .02).

Conclusions

Receiver operating characteristic analysis revealed that acute recoordination provided the best separation for prediction of CRT responders compared with acute resynchronization, baseline dyssynchrony, or baseline discoordination. LV recoordination after CRT is an acute phenomenon and predicts response to CRT at 6-month follow-up better than resynchronization.

Keywords: Cardiac resynchronization therapy, Discoordination, Dyssynchrony, Echocardiography, Speckle tracking

Abbreviations: AS-P delay, Time difference between the anteroseptal and posterior segments, CRT, Cardiac resynchronization therapy, EF, Ejection fraction, LV, Left ventricular, MD-6, Time difference between the earliest and latest segments of 6 segments, PROSPECT, Predictors of Response to CRT study, RDI, Radial discoordination index, RDI-B, 6 basal LV segments, RDI-M, 6 mid-LV segments, RDI-12, 12 LV segments, RS-SD, Standard deviation of times to peak strain for 6 segments