What does this research mean for the field?

A standard deviation of time to the first peak of circumferential strain greater than 116 ms measured by speckle tracking echocardiography independently predicts left ventricular volume response and clinical outcomes following cardiac resynchronization therapy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

December 26, 2014Circulation JournalOpen Access

The Speckle Tracking Imaging for the Assessment of Cardiac Resynchronization Therapy (START) Study

Q: What are the key findings of this study?

A standard deviation of time to first peak of circumferential strain >116 ms independently predicted volume response to cardiac resynchronization therapy (OR 9.83).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure (n=180). Intervention: Tfirst-SD of circumferential strain >116 ms vs. Tfirst-SD of circumferential strain ≤116 ms. Primary outcome: CRT volume responder (LV end-systolic volume reduction >15% at 6 months) (OR 9.83, 95% CI 3.78-25.6, p=<0.001).

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Key result

Marked circumferential strain dyssynchrony is linked to a ~10-fold higher likelihood of CRT volume response.

OR 9.83
95% CI 3.78-25.6
P<0.001
n=180

Why the study?

The feasibility of speckle tracking echocardiography to predict cardiac resynchronization therapy responders was not established in a prospective multicenter study.

Study Design

Type

Cohort (n=180)

Multicenter

Yes

PICO

Population

180 patients with drug-refractory heart failure, QRS duration ≥120 ms, and LVEF ≤35% undergoing cardiac resynchronization therapy, followed for a mean of 636 days.

Exposure / Comparator

Tfirst-SD of circumferential strain >116 ms vs Tfirst-SD of circumferential strain ≤116 ms

Primary Outcome

CRT volume responder (LV end-systolic volume reduction >15% at 6 months) — OR 9.83 (3.78-25.6), p=<0.001

Main Result

Odds Ratio: 9.83 (95% CI 3.78–25.6)

p-value: p=<0.001

Limitations

The accuracy of strain parameters was not as good as previously reported in single-center studies.
The study did not take into account lead position or myocardial viability.
The analysis was limited to time-to-peak analysis by speckle tracking echocardiography and did not evaluate newer dyssynchrony parameters such as wasted energy or discoordination analysis.

Discussion

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Implication

May refine CRT selection via strain dyssynchrony; hypothesis-generating pending prospective validation.

Cite This Study

Maruo et al. (2014) conducted a cohort in Heart failure (n=180). Tfirst-SD of circumferential strain >116 ms vs. Tfirst-SD of circumferential strain ≤116 ms was evaluated on CRT volume responder (LV end-systolic volume reduction >15% at 6 months) (OR 9.83, 95% CI 3.78-25.6, p=<0.001). A standard deviation of time to first peak of circumferential strain >116 ms independently predicted volume response to cardiac resynchronization therapy (OR 9.83).

synapsesocial.com/papers/6ac49848d2763de5e9ba6edd https://doi.org/10.1253/circj.cj-14-0842

Topics

Echocardiography

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The Speckle Tracking Imaging for the Assessment of Cardiac Resynchronization Therapy (START) Study

Study Design

PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Topics

The Speckle Tracking Imaging for the Assessment of Cardiac Resynchronization Therapy (START) Study

Study Design

PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider