Skip to main content
PMC home page
Heart logoLink to Heart
. 2004 Dec;90(Suppl 6):vi17–vi22. doi: 10.1136/hrt.2004.048322

Echocardiographic evaluation of cardiac dyssynchrony for predicting a favourable response to cardiac resynchronisation therapy

C Yu, J Bax, M Monaghan, P Nihoyannopoulos
PMCID: PMC1876327  PMID: 15564420

Full Text

The Full Text of this article is available as a PDF (277.9 KB).

Figure 1.

Figure 1

Open in a new tab

 Relation between the left ventricular dyssynchrony at baseline (expressed as septal-to-lateral delay) and the change in left ventricular (LV) ejection fraction after cardiac resynchronisation therapy (CRT).

Figure 2.

Figure 2

Open in a new tab

 A patient with left ventricular mechanical dyssynchrony in multiple segments before (panels A, C, E) and after (panels B, D, F) CRT. Before CRT, the apical four chamber view (A) shows only mild delay of basal lateral segment over the basal septal segment of 30 ms. In the apical two chamber view (C), there was severe delay in the basal inferior wall over the basal anterior wall of 130 ms which was significantly improved after CRT (D). In the apical long axis view (E), the basal posterior wall was delayed over the basal anteroseptal wall of 90 ms which was totally abolished after CRT (F). The peak systolic velocity during the ejection phase in each view are shown by the arrows.

Figure 3.

Figure 3

Open in a new tab

 The same patient in fig 2 showing the actual measurement of time to peak systolic velocity during the ejection phase (Ts) of all the six basal left ventricular segments before and after CRT. Before CRT there is a large variation of Ts in the basal segments. After CRT the Ts is homogenously delayed so that the contraction becomes delayed but synchronised in the left ventricle.

Figure 4.

Figure 4

Open in a new tab

 Parametric analysis of three dimensional LV datasets before and after resynchronisation therapy. At the top of each image is an LV cast generated from semi-automated border detection of the LV cavity. Regional contraction is calculated at multiple points over the entire LV endocardial surface and time to maximum contraction is colour coded and displayed on the lower polar maps. Regions with the most delayed contraction are displayed in red and can be seen in the septum before CRT. Following CRT, a significant improvement in the synchronicity of septal contraction is seen in that this area is now mainly coloured blue, as is the rest of the ventricle.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abraham William T., Fisher Westby G., Smith Andrew L., Delurgio David B., Leon Angel R., Loh Evan, Kocovic Dusan Z., Packer Milton, Clavell Alfredo L., Hayes David L. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002 Jun 13;346(24):1845–1853. doi: 10.1056/NEJMoa013168. [DOI] [PubMed] [Google Scholar]
  2. Achilli Augusto, Sassara Massimo, Ficili Sabina, Pontillo Daniele, Achilli Paola, Alessi Claudio, De Spirito Stefano, Guerra Roberto, Patruno Nicolino, Serra Francesco. Long-term effectiveness of cardiac resynchronization therapy in patients with refractory heart failure and "narrow" QRS. J Am Coll Cardiol. 2003 Dec 17;42(12):2117–2124. doi: 10.1016/j.jacc.2003.08.024. [DOI] [PubMed] [Google Scholar]
  3. Ansalone G., Giannantoni P., Ricci R., Trambaiolo P., Laurenti A., Fedele F., Santini M. Doppler myocardial imaging in patients with heart failure receiving biventricular pacing treatment. Am Heart J. 2001 Nov;142(5):881–896. doi: 10.1067/mhj.2001.117324. [DOI] [PubMed] [Google Scholar]
  4. Bax Jeroen J., Marwick Thomas H., Molhoek Sander G., Bleeker Gabe B., van Erven Lieselot, Boersma Eric, Steendijk Paul, van der Wall Ernst E., Schalij Martin J. Left ventricular dyssynchrony predicts benefit of cardiac resynchronization therapy in patients with end-stage heart failure before pacemaker implantation. Am J Cardiol. 2003 Nov 15;92(10):1238–1240. doi: 10.1016/j.amjcard.2003.06.016. [DOI] [PubMed] [Google Scholar]
  5. Bax Jeroen J., Molhoek Sander G., van Erven Lieselot, Voogd Paul J., Somer Soeresh, Boersma Eric, Steendijk Paul, Schalij Martin J., Van der Wall Ernst E. Usefulness of myocardial tissue Doppler echocardiography to evaluate left ventricular dyssynchrony before and after biventricular pacing in patients with idiopathic dilated cardiomyopathy. Am J Cardiol. 2003 Jan 1;91(1):94–97. doi: 10.1016/s0002-9149(02)03009-6. [DOI] [PubMed] [Google Scholar]
  6. Bristow Michael R., Saxon Leslie A., Boehmer John, Krueger Steven, Kass David A., De Marco Teresa, Carson Peter, DiCarlo Lorenzo, DeMets David, White Bill G. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004 May 20;350(21):2140–2150. doi: 10.1056/NEJMoa032423. [DOI] [PubMed] [Google Scholar]
  7. Cazeau S., Leclercq C., Lavergne T., Walker S., Varma C., Linde C., Garrigue S., Kappenberger L., Haywood G. A., Santini M. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med. 2001 Mar 22;344(12):873–880. doi: 10.1056/NEJM200103223441202. [DOI] [PubMed] [Google Scholar]
  8. Cleland J. G., Daubert J. C., Erdmann E., Freemantle N., Gras D., Kappenberger L., Klein W., Tavazzi L., CARE-HF study Steering Committee and Investigators The CARE-HF study (CArdiac REsynchronisation in Heart Failure study): rationale, design and end-points. Eur J Heart Fail. 2001 Aug;3(4):481–489. doi: 10.1016/s1388-9842(01)00176-3. [DOI] [PubMed] [Google Scholar]
  9. Garrigue S., Reuter S., Labeque J. N., Jais P., Hocini M., Shah D. C., Haissaguerre M., Clementy J. Usefulness of biventricular pacing in patients with congestive heart failure and right bundle branch block. Am J Cardiol. 2001 Dec 15;88(12):1436-41, A8. doi: 10.1016/s0002-9149(01)02131-2. [DOI] [PubMed] [Google Scholar]
  10. Gras Daniel, Leclercq Christophe, Tang Anthony S. L., Bucknall Cliff, Luttikhuis Henk Oude, Kirstein-Pedersen Anders. Cardiac resynchronization therapy in advanced heart failure the multicenter InSync clinical study. Eur J Heart Fail. 2002 Jun;4(3):311–320. doi: 10.1016/s1388-9842(02)00018-1. [DOI] [PubMed] [Google Scholar]
  11. Penicka Martin, Bartunek Jozef, De Bruyne Bernard, Vanderheyden Marc, Goethals Marc, De Zutter Marc, Brugada Pedro, Geelen Peter. Improvement of left ventricular function after cardiac resynchronization therapy is predicted by tissue Doppler imaging echocardiography. Circulation. 2004 Feb 9;109(8):978–983. doi: 10.1161/01.CIR.0000116765.43251.D7. [DOI] [PubMed] [Google Scholar]
  12. Pitzalis Maria Vittoria, Iacoviello Massimo, Romito Roberta, Massari Francesco, Rizzon Brian, Luzzi Giovanni, Guida Pietro, Andriani Andrea, Mastropasqua Filippo, Rizzon Paolo. Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony. J Am Coll Cardiol. 2002 Nov 6;40(9):1615–1622. doi: 10.1016/s0735-1097(02)02337-9. [DOI] [PubMed] [Google Scholar]
  13. Rouleau F., Merheb M., Geffroy S., Berthelot J., Chaleil D., Dupuis J. M., Victor J., Geslin P. Echocardiographic assessment of the interventricular delay of activation and correlation to the QRS width in dilated cardiomyopathy. Pacing Clin Electrophysiol. 2001 Oct;24(10):1500–1506. doi: 10.1046/j.1460-9592.2001.01500.x. [DOI] [PubMed] [Google Scholar]
  14. St John Sutton Martin G., Plappert Ted, Abraham William T., Smith Andrew L., DeLurgio David B., Leon Angel R., Loh Evan, Kocovic Dusan Z., Fisher Westby G., Ellestad Myrvin. Effect of cardiac resynchronization therapy on left ventricular size and function in chronic heart failure. Circulation. 2003 Mar 31;107(15):1985–1990. doi: 10.1161/01.CIR.0000065226.24159.E9. [DOI] [PubMed] [Google Scholar]
  15. Søgaard Peter, Egeblad Henrik, Kim W. Yong, Jensen Henrik K., Pedersen Anders K., Kristensen Bent Ø, Mortensen Peter T. Tissue Doppler imaging predicts improved systolic performance and reversed left ventricular remodeling during long-term cardiac resynchronization therapy. J Am Coll Cardiol. 2002 Aug 21;40(4):723–730. doi: 10.1016/s0735-1097(02)02010-7. [DOI] [PubMed] [Google Scholar]
  16. Turner Mark S., Bleasdale Rob A., Vinereanu Dragos, Mumford Catherine E., Paul Vince, Fraser Alan G., Frenneaux Michael P. Electrical and mechanical components of dyssynchrony in heart failure patients with normal QRS duration and left bundle-branch block: impact of left and biventricular pacing. Circulation. 2004 May 17;109(21):2544–2549. doi: 10.1161/01.CIR.0000131184.40893.40. [DOI] [PubMed] [Google Scholar]
  17. Xiao H. B., Roy C., Gibson D. G. Nature of ventricular activation in patients with dilated cardiomyopathy: evidence for bilateral bundle branch block. Br Heart J. 1994 Aug;72(2):167–174. doi: 10.1136/hrt.72.2.167. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Yu C-M, Lin H., Zhang Q., Sanderson J. E. High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration. Heart. 2003 Jan;89(1):54–60. doi: 10.1136/heart.89.1.54. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Yu Cheuk-Man, Chau Elaine, Sanderson John E., Fan Katherine, Tang Man-Oi, Fung Wing-Hong, Lin Hong, Kong Shun-Ling, Lam Yui-Ming, Hill Michael R. S. Tissue Doppler echocardiographic evidence of reverse remodeling and improved synchronicity by simultaneously delaying regional contraction after biventricular pacing therapy in heart failure. Circulation. 2002 Jan 29;105(4):438–445. doi: 10.1161/hc0402.102623. [DOI] [PubMed] [Google Scholar]
  20. Yu Cheuk-Man, Fung Jeffrey Wing-Hong, Zhang Qing, Chan Chi-Kin, Chan Yat-Sun, Lin Hong, Kum Leo C. C., Kong Shun-Ling, Zhang Yan, Sanderson John E. Tissue Doppler imaging is superior to strain rate imaging and postsystolic shortening on the prediction of reverse remodeling in both ischemic and nonischemic heart failure after cardiac resynchronization therapy. Circulation. 2004 Jun 14;110(1):66–73. doi: 10.1161/01.CIR.0000133276.45198.A5. [DOI] [PubMed] [Google Scholar]
  21. Yu Cheuk-Man, Fung Wing-Hong, Lin Hong, Zhang Qing, Sanderson John E., Lau Chu-Pak. Predictors of left ventricular reverse remodeling after cardiac resynchronization therapy for heart failure secondary to idiopathic dilated or ischemic cardiomyopathy. Am J Cardiol. 2003 Mar 15;91(6):684–688. doi: 10.1016/s0002-9149(02)03404-5. [DOI] [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES