Association between Presystolic Ventricular Flash and Left Ventricular Functional Recovery after Cardiac Resynchronization Therapy

The presence of septal flash (SF), an early inward/outward motion of the ventricular septum, has been reported to predict a fair response to cardiac resynchronization therapy (CRT) in patients with heart failure. Using speckle tracking echocardiography, we investigated whether the extent of pre-CRT SF was associated with left ventricular (LV) functional recovery after CRT device implantation. Fifteen patients with left bundle branch block with a mean LV ejection fraction of 23 ± 9% were enrolled in this study. The extent of presystolic ventricular flash (PSVF), which was defined if there was a peak in the radial strain curve in the preejection period, was semiquantified by counting the number of PSVF-positive segments. Patients underwent radial strain analysis before and between 3 and 6 months after CRT. After CRT device implantation, LV end-diastolic and end-systolic volumes were decreased, LV ejection fraction was increased, and LV filling time corrected by RR interval was increased. The number of PSVF-positive segments at baseline showed a graded association with improvement in both LV ejection fraction and LV filling time. In conclusion, the finding that a larger number of PSVF-positive segments before CRT predicted fair LV functional recovery after CRT suggests that PSVF may represent a substrate that is amenable to functional response to CRT.