Key result
Left ventricular dyssynchrony detected by combined pulsed wave and tissue Doppler imaging (TPW-TDI > 50 ms) predicted a positive response to cardiac resynchronization therapy with 98% sensitivity, 82% specificity, and an AUC of 0.92.
Why the study?
Does the combination of pulsed wave and tissue Doppler imaging predict a positive response to cardiac resynchronization therapy in patients with heart failure?
Observational (n=108)
No
Does the combination of pulsed wave and tissue Doppler imaging predict a positive response to cardiac resynchronization therapy in patients with heart failure?
Effect estimate: AUC 0.92
The combination of pulsed wave and tissue Doppler imaging is a highly reproducible and accurate method for predicting positive echocardiographic response to cardiac resynchronization therapy.
May support TPW-TDI for CRT response prediction in HF; hypothesis-generating and requires randomized validation before practice change.
INTRODUCTION: The combination of pulsed wave (PW) and tissue Doppler imaging (TDI) has been proposed as a new method to assess left ventricular (LV) mechanical dyssynchrony (LVMD), but results have not been validated. We investigated the correlation of a combination of PW and TDI with a positive response to cardiac resynchronization therapy (CRT). MATERIAL AND METHODS: We studied 108 consecutive patients who received CRT. Patients with atrial fibrillation were excluded. The time difference (T(PW-TDI)) between onset of QRS to the end of LV ejection by PW (T(PW)) and onset of QRS to the end of the systolic wave in LV basal segments with greatest delay by TDI (T(TDI)) was measured before CRT and during short-term and long-term follow-up. RESULTS: The T(PW-TDI) interval before CRT was 74 ±48 ms. Intra-observer variabilities for T(PW) and T(TDI) were 1.5 ±0.24% and 1 ±0.17%. Inter-observer variabilities for T(PW) and T(TDI) were 1 ±0.36% and 1 ±0.64%, respectively. T(PW-TDI) > 50 ms was defined as the cutoff value for diagnosis of LVMD by receiver operating curve (ROC) analysis. During follow-up of 15 ±11 months, the sensitivity and specificity of TP(PW-TDI) to predict a positive response to CRT were 98% and 82%, respectively. The area under the ROC curve was 0.92. There was a significant agreement between LVMD determined by T(PW-TDI) and the positive response to CRT (κ=0.80). CONCLUSIONS: Left vertricular dyssynchrony detected by the method combining PW and TDI demonstrated a high reproducibility, sensitivity, specificity and agreement with a positive response to CRT.
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Shen et al. (2010) conducted an observational in Heart failure with reduced ejection fraction and widened QRS (n=108). Combined pulsed wave and tissue Doppler imaging (TPW-TDI > 50 ms) vs. Standard CRT response criteria (LV end-systolic volume decrease ≥ 15%) was evaluated on Prediction of a positive response to CRT (AUC 0.92). Left ventricular dyssynchrony detected by combined pulsed wave and tissue Doppler imaging (TPW-TDI > 50 ms) predicted a positive response to cardiac resynchronization therapy with 98% sensitivity, 82% specificity, and an AUC of 0.92.