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European Heart Journal Advance Access originally published online on August 1, 2006
European Heart Journal 2006 27(20):2426-2432; doi:10.1093/eurheartj/ehl179
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Comparison of segmental and global markers of dyssynchrony in predicting clinical response to cardiac resynchronization

Alison M. Duncan*, Eric Lim, Jonathan Clague, Derek G. Gibson and Michael Y. Henein

Department of Echocardiography, Royal Brompton Hospital and, Imperial College, Sydney Street, London SW3 6NP, UK

Received 8 March 2006; revised 2 June 2006; accepted 14 July 2006; online publish-ahead-of-print 1 August 2006.

* Corresponding author. Tel: +44 207 351 8209; fax: +44 207 351 8604. E-mail address: a.duncan{at}imperial.ac.uk

See page 2380 for the editorial comment on this article (doi:10.1093/eurheartj/ehl247)

Aims Cardiac resynchronization therapy (CRT) reduces inter- and intraventricular dyssynchrony and shortens total isovolumic time (t-IVT). We compared the extent to which the values of ventricular dyssynchrony and t-IVT predict clinical benefits of CRT.

Methods and results Ventricular dyssynchrony was assessed in 39 patients with heart failure before and 6 months after CRT. Segmental dyssynchrony was identified from time to onset and peak systolic velocity of wall motion. T-IVT (s/min) was derived as [60–(total ejection time+total filling time)]. The difference between ventricular pre-ejection periods (D-PEP) was calculated. Outcome measures were fall in New York Heart Association (NYHA) class and increase in cardiac output (CO). Following CRT, NYHA class fell in 29/39 patients, CO increased (by 1.0 L/min, P<0.001), and intraventricular delay (Intra-VD), interventricular delay (Inter-VD), t-IVT, and D-PEP shortened (by 25 ms, 72 ms, 6 s/min, and 38 ms, P<0.01). NYHA class and CO were unchanged with CRT in 10/39, and Intra-VD, Inter-VD, t-IVT, and D-PEP lengthened (by 43 ms, 52 ms, 7 s/min, and 35 ms, P<0.05). Though univariate predictors of CO increment with CRT were Intra-VD, Inter-VD, t-IVT, and D-PEP, only pre-CRT values of CO (P<0.001), t-IVT (P<0.001), and D-PEP (P=0.025) were independent.

Conclusion Global, rather than segmental, measures of ventricular dyssynchrony are powerful, independent predictors of clinical response to CRT.

Key Words: Cardiac resynchronization therapy • Interventricular delay • Intraventricular delay • Total isovolumic time


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