Refining cardiac resynchronization therapy: a comprehensive review on the role of advanced multimodality imaging

Figures

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  Figure 1. The evaluation of the three types of mechanical dyssynchrony by Doppler echocardiography. Pulsed-wave Doppler assessment of atrioventricular dyssynchrony as the diastolic filling time relative to cardiac cycle duration (A); and interventricular dyssynchrony as the difference between LV pre-ejection time (B), and RV pre-ejection time (C) Tissue Doppler Imaging evaluation of intraventricular dyssynchrony as the basal septal to lateral wall delay (D) Representation of septal flash and apical rocking (E and F). LV, left ventricle; RV, right ventricle.

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  Figure 2. Two-dimensional speckle-tracking analysis of segmental left ventricular myocardial deformation showing the intraventricular dyssynchrony in the apical 4-chamber (A), 2-chamber (B) and 3-chamber (C) views. Myocardial work analysis showing increased GWW, and regional WW at the level of the septum, and low GWI, GCW and GWE (D) Left atrial strain analysis (E) and Right atrial strain analysis (F) showing reduced values in a patient with left ventricular dyssynchrony and left bundle branch block. GCW, global constructive work; GWE, global work efficiency; GWI, global work index.

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  Figure 3. Three-dimensional speckle-tracking analysis of left ventricular global longitudinal strain.

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  Figure 4. Cardiac magnetic resonance late gadolinium enhancement sequences for the assessment of myocardial scar tissue/fibrosis in four patients with dilated cardiomyopathy showing absence of LGE (A); localized LGE at the level of the inferior intraventricular septum on the RV insertion point (B); midwall linear fibrosis at the level of the intraventricular septum commonly known as “septal stripe” LGE, and at the level of the RV insertion points (C); and subendocardial antero-septal and anterior wall LGE (D) types B and C LGE pattern are typically found in patients with genetic/idiopathic etiologies of dilated cardiomyopathies, while pattern D suggests an ischaemic etiology. LGE, late gadolinium enhancement; RV, right ventricle.