Relation Between Strain Dyssynchrony Index Determined by Comprehensive Assessment Using Speckle-Tracking Imaging and Long-Term Outcome After Cardiac Resynchronization Therapy for Patients With Heart Failure
- 作者：Kazuhiro Tatsumi ; MD ; PhD ; Hidekazu Tanaka ; MD ; PhD ; tanakah@med.kobe-u.ac.jp ; Kensuke Matsumoto ; MD ; Akihiro Kaneko ; MD ; Takayuki Tsuji ; MD ; Keiko Ryo ; MD ; Yuko Fukuda ; MD ; Kazuko Norisada ; MD ; PhD ; Tetsuari Onishi ; MD ; PhD ; Akihiro Yoshida ; MD ; PhD ; Hiroya Kawai ; MD ; PhD ; Ken-Ichi Hirata ; MD ; PhD
- 刊名：The American Journal of Cardiology
- 出版年：2012
- 期刊代码：5_00029149
- 类别：med
- 出版时间：15 April, 2012
- 卷：109
- 期：8
- 页码：1187-1193
- 文件大小：1923 K
摘要
Strain dyssynchrony index (SDI), which was a marker of dyssynchrony and residual myocardial contractility, can predict left ventricular reverse remodeling short-term after cardiac resynchronization therapy (CRT). We investigated SDI-predicted long-term outcome after CRT in patients with heart failure (HF). We studied 74 patients with HF who underwent CRT. SDI was calculated as the average difference between peak and end-systolic strain from 6 segments for radial and circumferential SDIs and 18 segments for longitudinal SDI using 2-dimensional speckle-tracking strain. Based on our previous findings, the predefined cutoff for significant dyssynchrony and residual myocardial contractility was a radial SDI 鈮?.5%, a circumferential SDI 鈮?.2%, and a longitudinal SDI 鈮?.6%. The predefined principal outcome variable was the combined end point of death or hospitalization owing to deteriorating HF. Long-term follow-up after CRT was tracked over 4 years. The primary end point of prespecified events occurred in 14 patients (19%). An association with a favorable long-term outcome after CRT was observed in patients with significant radial, circumferential, and longitudinal SDIs (p <0.001, <0.005, and 0.010 vs patients without significant SDIs, respectively). Furthermore, cardiovascular event-free rate after CRT in patients with positivity of 3 for the 3 SDIs was 100%better than that in patients with positivity of 1 (52%, p <0.005) or 0 (31%, p <0.001) for the 3 SDIs. In conclusion, SDIs can successfully predict long-term outcome after CRT in patients with HF. Moreover, the approach combining the 3 types of SDI leads to a more accurate prediction than the use of individual parameters. These findings may have clinical implications in patients with CRT.