New Automatic Tools to Identify Responders to Cardiac Resynchronization Therapy - 04/10/16
Abstract |
Background |
New echocardiographic parameters (apical rocking [AR], septal flash [SF]) are intended to detect patterns specific to responders to cardiac resynchronization therapy (CRT). The patterns are visually recognized and qualitatively described, requiring experience and training. Speckle-tracking echocardiography can reflect SF and AR by using newly developed, dedicated parameters, such as start systolic index (SSI) and peak longitudinal displacement (PLD). The aim of this study was to investigate whether SSI and PLD can identify potential CRT responders.
Methods |
In 125 patients, echocardiograms from before and 9 ± 3 months after CRT were retrospectively analyzed with dedicated EchoPAC prerelease software. From speckle-tracking baseline images, color-coded bull's-eye displays of SSI and PLD were generated. Cutoff values for both parameters were derived from 25 randomly selected patients and applied to the remaining 100 patients to identify CRT response, defined as a decrease in end-systolic volume of ≥15% during follow-up. The performance of SSI and PLD was compared with the visual assessment of AR and SF by expert and novice readers.
Results |
Expert readers detected 77 patients with AR, identifying CRT responders with sensitivity and specificity of 85 ± 2% and 82 ± 2%, respectively. Novice readers reached 74 ± 7% sensitivity and 55 ± 11% specificity, while the sensitivity and specificity of the quantitative analysis were 72 ± 3% and 84 ± 4% for SSI and 80 ± 1% and 75 ± 2% for PLD, respectively.
Conclusions |
New speckle-tracking-based quantitative assessment of mechanical dyssynchrony by SSI and PLD performs comparably in identifying CRT responders as visual analysis by expert readers and performs significantly better than novice readers.
Le texte complet de cet article est disponible en PDF.Keywords : Cardiac resynchronization therapy, Candidate selection, Speckle tracking
Abbreviations : AR, AUC, BE, CRT, DER, LBBB, LV, PLD, SF, SSI, TEST
Plan
| Dr. Voigt holds a personal research mandate of the Flemish Research Foundation and received a research grant from the University Hospital Gasthuisberg. Dr. Stankovic received a research grant from the European Association of Cardiovascular Imaging. At the time of the study, Dr. Voigt had research agreements with Hitatchi-Aloka, Esaote, General Electric, Philips, Samsung, Siemens-Acuson, Toshiba, Tomtec, and Epsilon. Dr. Lysyansky is an employee of GE Ultrasound (Haifa, Israel). He developed and implemented the described algorithms and offered scientific and practical support for the evaluation of their performance. He was blinded to any patient data and was not involved in data processing, statistical analysis, or writing the manuscript. |
Vol 29 - N° 10
P. 966-972 - octobre 2016 Retour au numéro
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