End-systolic septal strain consistently predicted reverse remodeling after cardiac resynchronization therapy across all imaging techniques (CMR-TAG R2 0.60, CMR-FT R2 0.50, STE-circ R2 0.43).
Cohort (n=27)
Does strain imaging predict reverse remodeling response to cardiac resynchronization therapy in patients undergoing implantation?
End-systolic septal strain is a consistent predictor of reverse remodeling after CRT across multiple imaging modalities, providing predictive value beyond current guideline criteria.
Abstract Aims Various strain parameters and multiple imaging techniques are presently available including cardiovascular magnetic resonance (CMR) tagging (CMR-TAG), CMR feature tracking (CMR-FT), and speckle tracking echocardiography (STE). This study aims to compare predictive performance of different strain parameters and evaluate results per imaging technique to predict cardiac resynchronization therapy (CRT) response. Methods and results Twenty-seven patients were prospectively enrolled and underwent CMR and echocardiographic examination before CRT implantation. Strain analysis was performed in circumferential (CMR-TAG, CMR-FT, and STE-circ) and longitudinal (STE-long) orientations. Regional strain values, parameters of dyssynchrony, and discoordination were calculated. After 12 months, CRT response was measured by the echocardiographic change in left ventricular (LV) end-systolic volume (LVESV). Twenty-six patients completed follow-up; mean LVESV change was −29 ± 27% with 17 (65%) patients showing ≥15% LVESV reduction. Measures of dyssynchrony (SD-TTPLV) and discoordination (ISFLV) were strongly related to CRT response when using CMR-TAG (R2 0.61 and R2 0.57, respectively), but showed poor correlations for CMR-FT and STE (all R2 ≤ 0.32). In contrast, the end-systolic septal strain (ESSsep) parameter showed a consistent high correlation with LVESV change for all techniques (CMR-TAG R2 0.60; CMR-FT R2 0.50; STE-circ R2 0.43; and STE-long R2 0.43). After adjustment for QRS duration and QRS morphology, ESSsep remained an independent predictor of response per technique. Conclusions End-systolic septal strain was the only parameter with a consistent good relation to reverse remodelling after CRT, irrespective of assessment technique. In clinical practice, this measure can be obtained by any available strain imaging technique and provides predictive value on top of current guideline criteria.
Zweerink et al. (2018) conducted a cohort in Patients undergoing cardiac resynchronization therapy (CRT) (n=27). Strain imaging parameters (CMR-TAG, CMR-FT, STE) vs. Comparison between different strain parameters and imaging techniques was evaluated on CRT response measured by echocardiographic change in left ventricular end-systolic volume (LVESV). End-systolic septal strain consistently predicted reverse remodeling after cardiac resynchronization therapy across all imaging techniques (CMR-TAG R2 0.60, CMR-FT R2 0.50, STE-circ R2 0.43).