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Echocardiography for prediction of 6-month and late response to cardiac resynchronization therapy: implementation of stress echocardiography and comparative assessment along with widely used dyssynchrony indices

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Abstract

Non-response cardiac resynchronization therapy (CRT) remains an issue, despite the refinement of selection criteria. The purpose of this study was to investigate the role of stress echocardiography along with dyssynchrony parameters for identification of CRT responders or late responders. 106 symptomatic heart failure patients were examined before, 6 months and 2–4 years after CRT implementation. Inotropic contractile reserve (ICR) and inferolateral (IL) wall viability were studied by stress echocardiography. Dyssynchrony was assessed by: (1) Septal to posterior wall motion delay (SPWMD) by m-mode. (2) Septal to lateral wall delay (SLD) by TDI. (3) Interventricular mechanical delay (IVMD) by pulsed wave Doppler for (4) difference in time to peak circumferential strain (TmaxCS) by speckle tracking. (5) Apical rocking (ApR) and septal flash (SF) by visual assessment. At 6 months there were 54 responders, with 12 additional late responders. TmaxCS had the greatest predictive value with an area under curve (AUC) of 0.835, followed by the presence of both ICR and viability of IL wall (AUC 0.799), m-mode (AUC = 0.775) and presence of either ApR or SF (AUC = 0.772). Predictive ability of ApR and of ICR is augmented if late responders are also included. Performance of dyssynchrony parameters is enhanced, in patients with both ICR and IL wall viability. Stress echocardiography and dyssynchrony parameters are simple and reliable predictors of 6-month and late CRT response. A stepwise approach with an initial assessment of ICR and viability and, if positive, further dyssynchrony analysis, could assist decision making.

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Authors and Affiliations

  1. Department of Cardiology, Evagelismos General Hospital of Athens, 45 Ipsilandou st, 10676, Athens, Greece

    Emmanouil Poulidakis, Evangelos Giannoulis, Markos Koukos, Eleni Margioula & Ioannis Kallikazaros

  2. First Cardiology Clinic, Hippokration Hospital, University of Athens, 114 Vas. Sofias Ave, 11528, Athens, Greece

    Constantina Aggeli, Iosif Koutagiar, Stavroula Lagoudakou, Kostas Gatzoulis, Polychronis Dilaveris, Christodoulos Stefanadis & Dimitrios Tousoulis

  3. Cardiology Department, Hippokration Hospital, 114 Vas. Sofias Ave, 11528, Athens, Greece

    Skevos Sideris & Eliza Sfendouraki

  4. Cardiosurgery Department, Hippokration Hospital, 114 Vas. Sofias Ave, 11528, Athens, Greece

    Andreas Katsaros

  5. Department of Biological Chemistry, Medical School, University of Athens, 75 M. Asias st, 115 27, Athens, Greece

    Stavroula Couloheri

  6. Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris, France

    Emmanouil Poulidakis

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  1. Emmanouil Poulidakis
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Correspondence to Emmanouil Poulidakis.

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Emmanouil Poulidakis and Constantina Aggeli were responsible for the drafting of the manuscript.

Skevos Sideris, Eliza Sfendouraki, Iosif Koutagiar, Andreas Katsaros, Evangelos Giannoulis, Markos Koukos, Eleni Margioula, Stavroula Lagoudakou, Kostas Gatzoulis and Polychronis Dilaveris were involved in the patient management (clinical management and/or device implantation) and revised the manuscript.

Ioannis Kallikazaros, Stavroula Couloheri, Christodoulos Stefanadis and Dimitrios Tousoulis were supervisors.

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Poulidakis, E., Aggeli, C., Sideris, S. et al. Echocardiography for prediction of 6-month and late response to cardiac resynchronization therapy: implementation of stress echocardiography and comparative assessment along with widely used dyssynchrony indices. Int J Cardiovasc Imaging 35, 285–294 (2019). https://doi.org/10.1007/s10554-018-01520-6

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