Speckle-tracking echocardiography provides robust and reproducible markers of left ventricular dyssynchrony that can help predict response to cardiac resynchronisation therapy and guide optimal lead placement.
Does speckle-tracking echocardiography improve the assessment of dyssynchrony and prediction of response to cardiac resynchronisation therapy compared to traditional methods?
Speckle-tracking echocardiography offers a robust and sensitive method for assessing left ventricular dyssynchrony, predicting CRT response, and guiding LV lead placement in heart failure patients.
Cardiac resynchronisation therapy (CRT) can profoundly improve outcome in selected patients with heart failure; however, response is difficult to predict and can be absent in up to one in three patients. There has been a substantial amount of interest in the echocardiographic assessment of left ventricular dyssynchrony, with the ultimate aim of reliably identifying patients who will respond to CRT. The measurement of myocardial deformation (strain) has conventionally been assessed using tissue Doppler imaging (TDI), which is limited by its angle dependence and ability to measure in a single plane. Two-dimensional speckle-tracking echocardiography is a technique that provides measurements of strain in three planes, by tracking patterns of ultrasound interference ('speckles') in the myocardial wall throughout the cardiac cycle. Since its initial use over 15 years ago, it has emerged as a tool that provides more robust, reproducible and sensitive markers of dyssynchrony than TDI. This article reviews the use of two-dimensional and three-dimensional speckle-tracking echocardiography in the assessment of dyssynchrony, including the identification of echocardiographic parameters that may hold predictive potential for the response to CRT. It also reviews the application of these techniques in guiding optimal LV lead placement pre-implant, with promising results in clinical improvement post-CRT.
GKhan et al. (Tue,) conducted a review in Heart failure requiring cardiac resynchronisation therapy. Speckle-tracking echocardiography vs. Tissue Doppler imaging (TDI) or standard care was evaluated. Speckle-tracking echocardiography provides robust and reproducible markers of left ventricular dyssynchrony that can help predict response to cardiac resynchronisation therapy and guide optimal lead placement.