Easy-to-Use Comprehensive Speckle-Tracking Approach for Cardiac Resynchronization Therapy

BACKGROUND: Left ventricular (LV) dyssynchrony has emerged as an important mechanism contributing to the patient's response to cardiac resynchronization therapy (CRT), but other potential factors, especially LV myocardial viability, are also influential. METHODS AND RESULTS: We studied 132 patients undergoing CRT. LV dyssynchrony was determined by anteroseptal-to-posterior wall delay on the mid-LV short-axis view using 2-dimensional speckle-tracking radial strain (≥130 ms as significant). Global circumferential strain (GCS), considered as a parameter of LV intrinsic myocardial function, was also determined as the peak GCS from the same view. Long-term follow-up was tracked over 40 months. Kaplan-Meier analysis indicated that patients with GCS >3.9% experienced fewer cardiovascular events overall (log-rank P=0.034). Similarly, patients with GCS >3.9% and ≥6.6% experienced fewer cardiovascular events than those with GCS ≤3.9% and <6.6% among patients with and without LV dyssynchrony (log-rank P=0.025 and P=0.029, respectively). An important finding from multivariate Cox proportional hazards analysis was that LV dyssynchrony and GCS were independently associated with cardiovascular events. Of note, only 2±1 min per patient were needed to analyze both LV dyssynchrony and GCS from the same routine mid-LV short-axis view. CONCLUSIONS: This easy-to-use combined assessment of LV dyssynchrony and myocardial function using speckle-tracking strain from the same mid-LV short-axis view may well have clinical implications for CRT.