European Heart Journal Advance Access originally published online on March 30, 2006
European Heart Journal 2006 27(9):1070-1078; doi:10.1093/eurheartj/ehi814
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Left intraventricular myocardial deformation dyssynchrony identifies responders to cardiac resynchronization therapy in patients with heart failure
1 Chair of Cardiology, Azienda Ospedaliera Universitaria, Corso Giovecca 203, 44100 Ferrara, Italy
2 Fondazione Salvatore Maugeri, Brescia, Italy
3 Cardiac Unit, Casa di Cura S. Michele, Maddaloni, Italy
4 CNR Institute of Clinical Physiology, Pisa, Italy
5 Cardiac Unit, Policlinico di Monza, Monza, Italy
6 Division of Cardiology, Ospedale Civile, Piacenza, Italy
7 Cardiac Unit, Ospedale di Circolo, Busto Arsizio, Italy
8 Guidant, Italian Clinical Department
Received 7 June 2005; revised 5 January 2006; accepted 9 February 2006; online publish-ahead-of-print 30 March 2006.
* Corresponding author. Tel: +39 532 236269; fax: +39 532 236593. E-mail address: donatomele{at}libero.it
Aims We tested the hypothesis that dyssynchrony of left ventricular (LV) myocardial deformation evaluated by ultrasound can predict success of cardiac resynchronization therapy (CRT) in patients with heart failure (HF).
Methods and results Thirty-seven patients with dilated cardiomyopathy, New York Heart Association class III–IV, LV ejection fraction (EF) 
35%, QRS>120 ms were studied before, at pre-discharge, and after 3 and 6 months of CRT. The M-mode peak septal-to-posterior wall motion and thickening delay (SPWMD and SPWTD, ms) and the standard deviation of the averaged time-to-peak strain (TPS-SD, ms) of 12 middle and basal LV segments obtained from the three standard apical views were calculated. Responders were defined at month 6 by 
20% EF increase and/or 15% end-systolic volume (ESV) decrease with respect to baseline. Baseline SPWTD (not SPWMD) and TPS-SD differentiated responders from non-responders with good accuracy and reproducibility. A value 194 ms for SPWTD and 60 ms for TPS-SD was significantly associated with responder identification. Baseline dyssynchrony parameters correlated significantly with EF (r=0.53 for SPWTD and r=0.86 for TPS-SD) and ESV variations (r=–0.42 for SPWTD and r=–0.73 for TPS-SD).
Conclusion Patients with chronic HF should undergo ultrasound evaluation to quantify dyssynchrony of LV myocardial deformation, which would help identifying CRT responders.
Key Words: Heart failure • Resynchronization • Ultrasound
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