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European Heart Journal Advance Access published online on April 10, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm034
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Impact of left ventricular lead position in cardiac resynchronization therapy on left ventricular remodelling. A circumferential strain analysis based on 2D echocardiography

Michael Becker1, Rafael Kramann1, Andreas Franke1, Ole-A. Breithardt2, Nicole Heussen3, Christian Knackstedt1, Christoph Stellbrink4, Patrick Schauerte1, Malte Kelm1 and Rainer Hoffmann1,*

1 Medical Clinic I, Department of Cardiology, University RWTH Aachen, Pauwelsstraße 30, 52057 Aachen, Germany
2 Department of Cardiology, University Erlangen, Erlangen, Germany
3 Department of Medical Statistics, University RWTH Aachen, Aachen, Germany
4 Städtisches Krankenhaus Bielefeld, Department of Cardiology, Germany

Received 23 September 2006; revised 13 January 2007; accepted 2 February 2007.

* Corresponding author. Tel: +49 241 8088468; fax: +49 241 8082303. E-mail address: rhoffmann{at}ukaachen.de

Aims: To assess if myocardial deformation imaging allows definition of an optimal left ventricular (LV) lead position with improved effectiveness of cardiac resynchronization therapy (CRT) on LV reverse remodelling.

Methods: Circumferential strain imaging based on tracking of acoustic markers within 2D echo images (GE Ultrasound) was performed in 47 heart failure patients (59 ± 9 years, 28 men) at baseline, one day postoperatively, 3 and 10 months after initiation of CRT. Myocardial deformation imaging was used to determine1 the segment with latest peak negative systolic circumferential strain prior to CRT, and2 the segment with maximal temporal difference of peak strain before-to-on CRT as the segment with greatest benefit of CRT and assumed LV lead position. Anatomic LV lead position was determined by fluoroscopy. Optimal LV lead position was defined as concordance or immediate neighbouring of the segment with latest systolic strain prior to CRT and segment with assumed LV lead position.

Results: Agreement of assumed LV lead position based on strain analysis and LV lead position defined by fluoroscopy were high (kappa = 0.847). At 10 month follow-up, there was greater increase of EF (12 ± 3 vs. 7 ± 4%, P < 0.001), greater decrease of left ventricular end-diastolic volume (LVEDV) (23 ± 8 vs. 13 ± 7 mL, P < 0.001) and left ventricular end-systolic volume (LVESV) (42 ± 10 vs. 27 ± 8 mL, P < 0.001), and greater increase of VO2max (2.8 ± 0.8 vs. 1.9 ± 1.0 mL/kg/min, P = 0.035) in the optimal (n = 28 patients) compared to the non-optimal LV lead position group (n = 19 patients). The distance between segment with latest systolic strain prior to CRT and segment with assumed LV lead position was the only independent predictor of {Delta}LVEDV and {Delta}LVESV at 10 month follow-up (R2 = 0.2175, P = 0.0197) and (R2 = 0.3774, P = 0.0054), respectively.

Conclusion: Detailed analysis of the myocardial contraction sequence using circumferential strain imaging allows determination of the LV lead position in CRT. Optimal LV lead position in CRT defined by circumferential strain analysis results in greater improvement in LV function and more LV reverse remodelling than non-optimal LV lead position.

Key Words: Cardiac resynchronization therapy • Echocardiography • Heart failure • Left ventricular function • Pacing


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