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Global longitudinal strain predicts responders after cardiac resynchronization therapy—a systematic review and meta-analysis

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Abstract

To evaluate the association between baseline global longitudinal strain (GLS) and ΔGLS (difference of baseline GLS and follow-up) and cardiac resynchronization therapy (CRT) response defined either with clinical or with echocardiographic characteristics. This meta-analysis was performed in accordance to both the Meta-Analysis of Observational Studies in Epidemiology and Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Two independent investigators performed a comprehensive systematic search in MedLine, EMBASE and Cochrane databases through September 2019 without limitations. Data analysis was performed by using the Review Manager software (RevMan), version 5.3, and Stata 13 software. A p value of less than 0.05 (two-tailed) was considered statistically significant. Twelve studies (1004 patients, mean age 63.8 years old, males 69.4%) provided data on the association of baseline GLS with the response to CRT therapy. We found that CRT responders had significantly better resting GLS values compared with non-responders [GLS mean difference −2.13 (−3.03, −1.23), p < 0.001, I2 78%]. Furthermore, CRT responders had significantly greater improvement of GLS at follow-up compared with non-responders [ΔGLS mean difference −3.20 (−4.95, −1.45), p < 0.001, I2 66%]. These associations remained significant in a subgroup analysis including only studies with similar CRT response definition. In this meta-analysis, we found that CRT responders had a baseline and ΔGLS significantly higher than the non-responders strengthening the central role of GLS as a tool for selecting candidates for CRT. Furthermore, improved GLS values after CRT may be used to better define CRT responders.

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References

  1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Authors/Task Force M, Document R (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 18(8):891–975. https://doi.org/10.1002/ejhf.592

    Article  PubMed  Google Scholar 

  2. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL (2013) 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 128(16):1810–1852. https://doi.org/10.1161/CIR.0b013e31829e8807

    Article  PubMed  Google Scholar 

  3. Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, Kocovic DZ, Packer M, Clavell AL, Hayes DL, Ellestad M, Trupp RJ, Underwood J, Pickering F, Truex C, McAtee P, Messenger J, Evaluation MSGMIRC (2002) Cardiac resynchronization in chronic heart failure. N Engl J Med 346(24):1845–1853. https://doi.org/10.1056/NEJMoa013168

    Article  PubMed  Google Scholar 

  4. Fornwalt BK, Sprague WW, BeDell P, Suever JD, Gerritse B, Merlino JD, Fyfe DA, Leon AR, Oshinski JN (2010) Agreement is poor among current criteria used to define response to cardiac resynchronization therapy. Circulation 121(18):1985–1991. https://doi.org/10.1161/CIRCULATIONAHA.109.910778

    Article  PubMed  PubMed Central  Google Scholar 

  5. Antonio N, Teixeira R, Lourenco C, Saraiva F, Coelho L, Martins R, Ventura M, Cristovao J, Guimaraes H, Elvas L, Goncalves L, Providencia LA (2009) Which echocardiographic definition should be used to define response to cardiac resynchronization therapy? Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology 28(9):943–958

  6. Rickard J, Michtalik H, Sharma R, Berger Z, Iyoha E, Green AR, Haq N, Robinson KA (2016) Predictors of response to cardiac resynchronization therapy: a systematic review. Int J Cardiol 225:345–352. https://doi.org/10.1016/j.ijcard.2016.09.078

    Article  PubMed  Google Scholar 

  7. Normand C, Linde C, Singh J, Dickstein K (2018) Indications for cardiac resynchronization therapy: a comparison of the major international guidelines. JACC Heart Fail 6(4):308–316. https://doi.org/10.1016/j.jchf.2018.01.022

    Article  PubMed  Google Scholar 

  8. Marechaux S, Menet A, Guyomar Y, Ennezat PV, Guerbaai RA, Graux P, Tribouilloy C (2016) Role of echocardiography before cardiac resynchronization therapy: new advances and current developments. Echocardiography 33(11):1745–1752. https://doi.org/10.1111/echo.13334

    Article  PubMed  Google Scholar 

  9. Smiseth OA, Torp H, Opdahl A, Haugaa KH, Urheim S (2016) Myocardial strain imaging: how useful is it in clinical decision making? Eur Heart J 37(15):1196–1207. https://doi.org/10.1093/eurheartj/ehv529

    Article  PubMed  Google Scholar 

  10. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283(15):2008–2012

    Article  CAS  Google Scholar 

  11. Marshall SC, Molnar F, Man-Son-Hing M, Blair R, Brosseau L, Finestone HM, Lamothe C, Korner-Bitensky N, Wilson KG (2007) Predictors of driving ability following stroke: a systematic review. Top Stroke Rehabil 14(1):98–114. https://doi.org/10.1310/tsr1401-98

    Article  PubMed  Google Scholar 

  12. D’Andrea A, Caso P, Scarafile R, Riegler L, Salerno G, Castaldo F, Gravino R, Cocchia R, Del Viscovo L, Limongelli G, Di Salvo G, Ascione L, Iengo R, Cuomo S, Santangelo L, Calabro R (2009) Effects of global longitudinal strain and total scar burden on response to cardiac resynchronization therapy in patients with ischaemic dilated cardiomyopathy. Eur J Heart Fail 11(1):58–67. https://doi.org/10.1093/eurjhf/hfn010

    Article  PubMed  Google Scholar 

  13. Fournet M, Bernard A, Marechaux S, Galli E, Martins R, Mabo P, Daubert JC, Leclercq C, Hernandez A, Donal E (2017) Pilot study using 3D-longitudinal strain computation in a multi-parametric approach for best selecting responders to cardiac resynchronization therapy. Cardiovasc Ultrasound 15(1):15. https://doi.org/10.1186/s12947-017-0107-6

    Article  PubMed  PubMed Central  Google Scholar 

  14. Galli E, Leclercq C, Hubert A, Bernard A, Smiseth OA, Mabo P, Samset E, Hernandez A, Donal E (2018) Role of myocardial constructive work in the identification of responders to CRT. Eur Heart J Cardiovasc Imaging 19(9):1010–1018. https://doi.org/10.1093/ehjci/jex191

    Article  PubMed  Google Scholar 

  15. Hasselberg NE, Haugaa KH, Bernard A, Ribe MP, Kongsgaard E, Donal E, Edvardsen T (2016) Left ventricular markers of mortality and ventricular arrhythmias in heart failure patients with cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 17(3):343–350. https://doi.org/10.1093/ehjci/jev173

    Article  PubMed  Google Scholar 

  16. Iwano H, Yamada S, Watanabe M, Mitsuyama H, Nishino H, Yokoyama S, Kaga S, Nishida M, Yokoshiki H, Onozuka H, Mikami T, Tsutsui H (2011) Novel strain rate index of contractility loss caused by mechanical dyssynchrony. - A predictor of response to cardiac resynchronization therapy. Circulation journal : official journal of the Japanese Circulation Society 75(9):2167–2175. https://doi.org/10.1253/circj.cj-10-1099

    Article  Google Scholar 

  17. Kang Y, Cheng L, Cui J, Li L, Qin S, Su Y, Mao J, Gong X, Chen H, Pan C, Shen X, He B, Shu X (2015) A new score system for predicting response to cardiac resynchronization therapy. Cardiol J 22(2):179–187. https://doi.org/10.5603/CJ.a2014.0089

    Article  PubMed  Google Scholar 

  18. Kydd AC, Khan F, Gopalan D, Ring L, Rana BS, Virdee MS, Dutka DP (2014) Utility of speckle tracking echocardiography to characterize dysfunctional myocardium in patients with ischemic cardiomyopathy referred for cardiac resynchronization therapy. Echocardiography 31(6):736–743. https://doi.org/10.1111/echo.12458

    Article  PubMed  Google Scholar 

  19. Ma CY, Liu S, Yang J, Tang L, Zhang LM, Li N, Yu B (2014) Evaluation of global longitudinal strain of left ventricle and regional longitudinal strain in the region of left ventricular leads predicts the response to cardiac resynchronization therapy in patients with ischemic heart failure. Cell Biochem Biophys 70(1):143–148. https://doi.org/10.1007/s12013-014-9870-2

    Article  CAS  PubMed  Google Scholar 

  20. Park JH, Negishi K, Grimm RA, Popovic Z, Stanton T, Wilkoff BL, Marwick TH (2013) Echocardiographic predictors of reverse remodeling after cardiac resynchronization therapy and subsequent events. Circ Cardiovasc Imaging 6(6):864–872. https://doi.org/10.1161/CIRCIMAGING.112.000026

    Article  PubMed  Google Scholar 

  21. Risum N, Jons C, Olsen NT, Fritz-Hansen T, Bruun NE, Hojgaard MV, Valeur N, Kronborg MB, Kisslo J, Sogaard P (2012) Simple regional strain pattern analysis to predict response to cardiac resynchronization therapy: rationale, initial results, and advantages. Am Heart J 163(4):697–704. https://doi.org/10.1016/j.ahj.2012.01.025

    Article  PubMed  Google Scholar 

  22. Yang N, Liang ZG, Wang ZJ, Liu H, Chi C, Tian YF, Qi SH, Wang BY, Han W (2017) Combined myocardial deformation to predict cardiac resynchronization therapy response in nonischemic cardiomyopathy. Pacing Clin Electrophysio : PACE 40(9):986–994. https://doi.org/10.1111/pace.13151

    Article  Google Scholar 

  23. Zhu M, Chen H, Fulati Z, Liu Y, Su Y, Shu X (2019) Left ventricular global longitudinal strain and mechanical dispersion predict response to multipoint pacing for cardiac resynchronization therapy. J Clin Ultrasound : JCU 47(6):356–365. https://doi.org/10.1002/jcu.22687

    Article  PubMed  Google Scholar 

  24. Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, Cleland J, Deharo JC, Delgado V, Elliott PM, Gorenek B, Israel CW, Leclercq C, Linde C, Mont L, Padeletti L, Sutton R, Vardas PE, Guidelines ESCCfP, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Document R, Kirchhof P, Blomstrom-Lundqvist C, Badano LP, Aliyev F, Bansch D, Baumgartner H, Bsata W, Buser P, Charron P, Daubert JC, Dobreanu D, Faerestrand S, Hasdai D, Hoes AW, Le Heuzey JY, Mavrakis H, McDonagh T, Merino JL, Nawar MM, Nielsen JC, Pieske B, Poposka L, Ruschitzka F, Tendera M, Van Gelder IC, Wilson CM (2013) 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J 34(29):2281–2329. https://doi.org/10.1093/eurheartj/eht150

  25. Chung ES, Leon AR, Tavazzi L, Sun JP, Nihoyannopoulos P, Merlino J, Abraham WT, Ghio S, Leclercq C, Bax JJ, Yu CM, Gorcsan J 3rd, St John Sutton M, De Sutter J, Murillo J (2008) Results of the Predictors of Response to CRT (PROSPECT) trial. Circulation 117(20):2608–2616. https://doi.org/10.1161/CIRCULATIONAHA.107.743120

    Article  PubMed  Google Scholar 

  26. Amundsen BH, Helle-Valle T, Edvardsen T, Torp H, Crosby J, Lyseggen E, Stoylen A, Ihlen H, Lima JA, Smiseth OA, Slordahl SA (2006) Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll Cardiol 47(4):789–793. https://doi.org/10.1016/j.jacc.2005.10.040

    Article  PubMed  Google Scholar 

  27. Ingul CB, Torp H, Aase SA, Berg S, Stoylen A, Slordahl SA (2005) Automated analysis of strain rate and strain: feasibility and clinical implications. J Am Soc Echocardiogr : official publication of the American Society of Echocardiography 18(5):411–418. https://doi.org/10.1016/j.echo.2005.01.032

    Article  Google Scholar 

  28. Paoletti Perini A, Sacchi S, Votta CD, Lilli A, Attana P, Pieragnoli P, Ricciardi G, Bani R, Padeletti L (2016) Left ventricular rotational dyssynchrony before cardiac resynchronization therapy: a step forward into ventricular mechanics. Journal of cardiovascular medicine 17(7):469–477. https://doi.org/10.2459/JCM.0000000000000391

    Article  CAS  PubMed  Google Scholar 

  29. van der Bijl P, Kostyukevich MV, Khidir M, Ajmone Marsan N, Delgado V, Bax JJ (2019) Left ventricular remodelling and change in left ventricular global longitudinal strain after cardiac resynchronization therapy: prognostic implications. European heart journal cardiovascular Imaging 20(10):1112–1119. https://doi.org/10.1093/ehjci/jez072

    Article  PubMed  Google Scholar 

  30. Bax JJ, Delgado V, Sogaard P, Singh JP, Abraham WT, Borer JS, Dickstein K, Gras D, Brugada J, Robertson M, Ford I, Krum H, Holzmeister J, Ruschitzka F, Gorcsan J (2017) Prognostic implications of left ventricular global longitudinal strain in heart failure patients with narrow QRS complex treated with cardiac resynchronization therapy: a subanalysis of the randomized EchoCRT trial. Eur Heart J 38(10):720–726. https://doi.org/10.1093/eurheartj/ehw506

    Article  CAS  PubMed  Google Scholar 

  31. Gorcsan J 3rd, Anderson CP, Tayal B, Sugahara M, Walmsley J, Starling RC, Lumens J (2019) Systolic stretch characterizes the electromechanical substrate responsive to cardiac resynchronization therapy. JACC Cardiovasc Imaging 12(9):1741–1752. https://doi.org/10.1016/j.jcmg.2018.07.013

    Article  PubMed  Google Scholar 

  32. Singh JP, Klein HU, Huang DT, Reek S, Kuniss M, Quesada A, Barsheshet A, Cannom D, Goldenberg I, McNitt S, Daubert JP, Zareba W, Moss AJ (2011) Left ventricular lead position and clinical outcome in the multicenter automatic defibrillator implantation trial-cardiac resynchronization therapy (MADIT-CRT) trial. Circulation 123(11):1159–1166. https://doi.org/10.1161/CIRCULATIONAHA.110.000646

    Article  PubMed  Google Scholar 

  33. Zhang X, Qian Z, Tang H, Hua W, Su Y, Xu G, Liu X, Xue X, Fan J, Cai L, Zhu L, Wang Y, Hou X, Garcia EV, Zhou W, Zou J (2019) A new method to recommend left ventricular lead positions for improved CRT volumetric response and long-term prognosis. J Nucl Cardiol. https://doi.org/10.1007/s12350-019-01735-7

    Article  PubMed  Google Scholar 

  34. Haghjoo M, Bonakdar HR, Jorat MV, Fazelifar AF, Alizadeh A, Ojaghi-Haghjghi Z, Esmaielzadeh M, Sadr-Ameli MA (2009) Effect of right ventricular lead location on response to cardiac resynchronization therapy in patients with end-stage heart failure. Europace 11(3):356–363. https://doi.org/10.1093/europace/eun375

    Article  PubMed  Google Scholar 

  35. Stephansen C, Sommer A, Kronborg MB, Jensen JM, Norgaard BL, Gerdes C, Kristensen J, Jensen HK, Fyenbo DB, Bouchelouche K, Nielsen JC (2019) Electrically vs. imaging-guided left ventricular lead placement in cardiac resynchronization therapy: a randomized controlled trial. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 21(9):1369–1377. https://doi.org/10.1093/europace/euz184

  36. Sipula D, Kozak M, Sipula J, Homza M, Plasek J, Furst TM (2019) Optimization of cardiac resynchronization therapy based on speckle tracking. Bratisl Lek Listy 120(8):552–557. https://doi.org/10.4149/BLL_2019_089

    Article  CAS  PubMed  Google Scholar 

  37. Rinaldi CA, Kranig W, Leclercq C, Kacet S, Betts T, Bordachar P, Gutleben KJ, Shetty A, Keel A, Ryu K, Farazi TG, Simon M, Naqvi TZ (2013) Acute effects of multisite left ventricular pacing on mechanical dyssynchrony in patients receiving cardiac resynchronization therapy. J Card Fail 19(11):731–738. https://doi.org/10.1016/j.cardfail.2013.10.003

    Article  PubMed  Google Scholar 

  38. Rinaldi CA, Leclercq C, Kranig W, Kacet S, Betts T, Bordachar P, Gutleben KJ, Shetty A, Donal E, Keel A, Ryu K, Farazi TG, Simon M, Naqvi TZ (2014) Improvement in acute contractility and hemodynamics with multipoint pacing via a left ventricular quadripolar pacing lead. J Interv Card Electrophysiol 40(1):75–80. https://doi.org/10.1007/s10840-014-9891-1

    Article  PubMed  Google Scholar 

  39. Leclercq C, Burri H, Curnis A, Delnoy PP, Rinaldi CA, Sperzel J, Lee K, Calo L, Vicentini A, Concha JF, Thibault B (2019) Cardiac resynchronization therapy non-responder to responder conversion rate in the more response to cardiac resynchronization therapy with MultiPoint Pacing (MORE-CRT MPP) study: results from Phase I. Eur Heart J 40(35):2979–2987. https://doi.org/10.1093/eurheartj/ehz109

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Second Department of Cardiology, General Hospital of Athens “Evangelismos”, Athens, Greece

    George Bazoukis

  2. Department of Cardiology, Helena Venizelou Hospital, Athens, Greece

    Costas Thomopoulos

  3. Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, 300211, Tianjin, P. R. China

    Gary Tse

  4. First Cardiology Clinic, Hippokration Hospital, University of Athens, Athens, Greece

    Konstantinos Tsioufis

  5. Imperial College London, NHLI, National Heart & Lung Institute, London, UK

    Petros Nihoyannopoulos

  6. Imperial College London, NHLI, Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK

    Petros Nihoyannopoulos

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Bazoukis, G., Thomopoulos, C., Tse, G. et al. Global longitudinal strain predicts responders after cardiac resynchronization therapy—a systematic review and meta-analysis. Heart Fail Rev 27, 827–836 (2022). https://doi.org/10.1007/s10741-021-10094-w

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