Skip to main content
SpringerLink
Log in

Echocardiographic assessment of ventricular dyssynchrony

  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

Although cardiac resynchronization therapy (CRT) has been of unquestioned therapeutic benefit to many patients with heart failure identified by a widened QRS complex on an electrocardiogram, many patients do not respond favorably. Several studies using echocardiographic methods to measure abnormalities of mechanical activation, known as dyssynchrony, have been proposed to improve patient selection for CRT. Many single-center studies from institutions with special expertise have demonstrated the feasibility of echocardiographic dyssynchrony to potentially assist with patient selection. However, the PROSPECT trial, a recent large multicenter study, highlighted the technical challenges in echocardiographic dyssynchrony analysis in mainstream clinical practice. Accordingly, a uniform clinical approach has not been established, and refinements of echocardiographic approaches and methods are constantly evolving. This article reviews current echocardiographic methods to quantify ventricular dyssynchrony, their strengths and limitations, and the proposed and potential expanding clinical applications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Hunt SA, Abraham WT, Chin MH, et al.: ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 2005, 112:e154–e235.

    Article  PubMed  Google Scholar 

  2. Cleland JG, Daubert JC, Erdmann E, et al.: The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005, 352:1539–1549.

    Article  PubMed  CAS  Google Scholar 

  3. Abraham WT, Fisher WG, Smith AL, et al.: Cardiac resynchronization in chronic heart failure. N Engl J Med 2002, 346:1845–1853.

    Article  PubMed  Google Scholar 

  4. Bax JJ, Abraham T, Barold SS, et al.: Cardiac resynchronization therapy: part 1—issues before device implantation. J Am Coll Cardiol 2005, 46:2153–2167.

    Article  PubMed  Google Scholar 

  5. Bax JJ, Ansalone G, Breithardt OA, et al.: Echocardiographic evaluation of cardiac resynchronization therapy: ready for routine clinical use? A critical appraisal. J Am Coll Card 2004, 44:1–9.

    Article  Google Scholar 

  6. Bax JJ, Bleeker GB, Marwick TH, et al.: Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. J Am Coll Cardiol 2004, 44:1834–1840.

    Article  PubMed  Google Scholar 

  7. Yu CM, Wing-Hong Fung J, et al.: Understanding nonresponders of cardiac resynchronization therapy—current and future perspectives. J Cardiovasc Electrophysiol 2005, 16:1117–1124.

    Article  PubMed  Google Scholar 

  8. Yu CM, Bleeker GB, Fung JW, et al.: Left ventricular reverse remodeling but not clinical improvement predicts long-term survival after cardiac resynchronization therapy. Circulation 2005, 112:1580–1586.

    Article  PubMed  Google Scholar 

  9. Bax JJ, Marwick TH, Molhoek SG, et al.: Left ventricular dyssynchrony predicts benefit of cardiac resynchronization therapy in patients with end-stage heart failure before pacemaker implantation. Am J Cardiol 2003, 92:1238–1240.

    Article  PubMed  Google Scholar 

  10. Bax JJ, Molhoek SG, van Erven L, et al.: 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, 91:94–97.

    Article  PubMed  Google Scholar 

  11. Yu CM, Zhang Q, Chan YS, et al.: Tissue Doppler velocity is superior to displacement and strain mapping in predicting left ventricular reverse remodeling response after cardiac resynchronization therapy. Heart 2006, 92:1452–1456.

    Article  PubMed  Google Scholar 

  12. Yu CM, Zhang Q, Fung JWH, et al.: A novel tool to assess systolic asynchrony and identify responders of cardiac resynchronization therapy by tissue synchronization imaging. J Am Coll Cardiol 2005, 45:677–684.

    Article  PubMed  Google Scholar 

  13. Yu Y, Kramer A, Spinelli J, et al.: Biventricular mechanical asynchrony predicts hemodynamic effect of uni-and biventricular pacing. Am J Physiol Heart Circ Physiol 2003, 285:H2788–H2796.

    PubMed  CAS  Google Scholar 

  14. Gorcsan J, Tanabe M, Bleeker GB, et al.: Combined longitudinal and radial dyssynchrony predicts ventricular response after resynchronization therapy. J Am Coll Cardiol 2007, 50:1476–1483.

    Article  PubMed  Google Scholar 

  15. Gorcsan J, Kanzaki H, Bazaz R, et al.: Usefulness of echocardiographic tissue synchronization imaging to predict acute response to cardiac resynchronization therapy. Am J Cardiol 2004, 93:1178–1181.

    Article  PubMed  Google Scholar 

  16. Yu CM, Chau E, Sanderson JE, et al.: Tissue Doppler echocardiographic evidence of reverse remodeling and improved synchronicity by simultaneously delaying regional contraction after biventricular pacing therapy in heart failure. Circulation 2002, 105:438–445.

    Article  PubMed  Google Scholar 

  17. Yu CM, Fung JW, Zhang Q, et al.: 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, 110:66–73.

    Article  PubMed  Google Scholar 

  18. Tournoux FB, Alabiad C, Fan D, et al.: Echocardiographic measures of acute haemodynamic response after cardiac resynchronization therapy predict long-term clinical outcome. Eur Heart J 2007, 28:1143–1148.

    Article  PubMed  Google Scholar 

  19. Yu CM, Abraham WT, Bax J, et al.: Predictors of response to cardiac resynchronization therapy (PROSPECT)—study design. Am Heart J 2005, 149:600–605.

    Article  PubMed  Google Scholar 

  20. Ghio S, Chung E, Leon A, et al.: Predictors of response to resynchronization therapy [abstract]. Presented at the European Society of Cardiology Congress 2007. Vienna; September 4, 2007.

  21. Cazeau S, Alonso C, Jauvert G, et al.: Cardiac resynchronization therapy. Europace 2004, 5(Suppl 1):S42–S48.

    Article  PubMed  Google Scholar 

  22. Cazeau S, Bordachar P, Jauvert G, et al.: Echocardiographic modeling of cardiac dyssynchrony before and during multisite stimulation: a prospective study. Pacing Clin Electrophysiol 2003, 26:137–143.

    Article  PubMed  CAS  Google Scholar 

  23. Cazeau S, Gras D, Lazarus A, et al.: Multisite stimulation for correction of cardiac asynchrony. Heart 2000, 84:579–581.

    Article  PubMed  CAS  Google Scholar 

  24. Achilli A, Peraldo C, Sassara M, et al.: Prediction of response to cardiac resynchronization therapy: the selection of candidates for CRT (SCART) study. Pacing Clin Electrophysiol 2006, 29(Suppl 2):S11–S19.

    Article  PubMed  Google Scholar 

  25. Richardson M, Freemantle N, Calvert MJ, et al.: Predictors and treatment response with cardiac resynchronization therapy in patients with heart failure characterized by dyssynchrony: a pre-defined analysis from the CARE-HF trial. Eur Heart J 2007, 28:1827–1834.

    Article  PubMed  Google Scholar 

  26. Kass D: Left ventricular versus biventricular pacing in cardiac resynchronization therapy: the plot in this tale of two modes. J Cardiovasc Electrophysiol 2004, 15:1348–1349.

    Article  PubMed  Google Scholar 

  27. Kass DA: Ventricular resynchronization: pathophysiology and identification of responders. Rev Cardiovasc Med 2003, 4(Suppl 2):S3–S13.

    PubMed  Google Scholar 

  28. Pitzalis MV, Iacoviello M, Romito R, et al.: Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony. J Am Coll Cardiol 2002, 40:1615–1622.

    Article  PubMed  Google Scholar 

  29. Marcus GM, Rose E, Viloria EM, et al.: Septal to posterior wall motion delay fails to predict reverse remodeling or clinical improvement in patients undergoing cardiac resynchronization therapy. J Am Coll Cardiol 2005, 46:2208–2214.

    Article  PubMed  Google Scholar 

  30. Bax JJ, Abraham T, Barold SS, et al.: Cardiac resynchronization therapy: part 2—issues during and after device implantation and unresolved questions. J Am Coll Cardiol 2005, 46:2168–2182.

    Article  PubMed  Google Scholar 

  31. Yu CM, Fung WH, Lin H, et al.: Predictors of left ventricular reverse remodeling after cardiac resynchronization therapy for heart failure secondary to idiopathic dilated or ischemic cardiomyopathy. Am J Cardiol 2003, 91:684–688.

    Article  PubMed  Google Scholar 

  32. Yu CM, Gorcsan J 3rd, Bleeker GB, et al.: Usefulness of tissue Doppler velocity and strain dyssynchrony for predicting left ventricular reverse remodeling response after cardiac resynchronization therapy. Am J Cardiol 2007, 100:1263–1270.

    Article  PubMed  Google Scholar 

  33. Sogaard P, Egeblad H, Kim WY, et al.: Tissue Doppler imaging predicts improved systolic performance and reversed left ventricular remodeling during long-term cardiac resynchronization therapy. J Am Coll Cardiol 2002, 40:723–730.

    Article  PubMed  Google Scholar 

  34. Penicka M, Bartunek J, De Bruyne B, et al.: Improvement of left ventricular function after cardiac resynchronization therapy is predicted by tissue Doppler imaging echocardiography. Circulation 2004, 109:978–983.

    Article  PubMed  Google Scholar 

  35. Suffoletto MS, Dohi K, Cannesson M, et al.: Novel speckle tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy. Circulation 2006, 113:960–968.

    Article  PubMed  Google Scholar 

  36. Kapetanakis S, Kearney MT, Siva A, et al.: Real-time three-dimensional echocardiography: a novel technique to quantify global left ventricular mechanical dyssynchrony. Circulation 2005, 112:992–1000.

    Article  PubMed  CAS  Google Scholar 

  37. Horstman JA, Monaghan MJ, Gill EA: Intraventricular dyssynchrony assessment by real-time three-dimensional echocardiography. Cardiol Clin 2007, 25:253–260.

    Article  PubMed  Google Scholar 

  38. Bleeker GB, Schalij MJ, Molhoek SG, et al.: Frequency of left ventricular dyssynchrony in patients with heart failure and a narrow QRS complex. Am J Cardiol 2005, 95:140–142.

    Article  PubMed  Google Scholar 

  39. Yu CM, Lin H, Zhang Q, Sanderson JE: High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration. Heart 2003, 89:54–60.

    Article  PubMed  Google Scholar 

  40. Yu CM, Chan YS, Zhang Q, et al.: Benefits of cardiac resynchronization therapy for heart failure patients with narrow QRS complexes and coexisting systolic asynchrony by echocardiography. J Am Coll Cardiol 2006, 48:2251–2257.

    Article  PubMed  Google Scholar 

  41. Bleeker GB, Holman ER, Steendijk P, et al.: Cardiac resynchronization therapy in patients with a narrow QRS complex. J Am Coll Cardiol 2006, 48:2243–2250.

    Article  PubMed  Google Scholar 

  42. Beshai JF, Grimm RA, Nagueh SF, et al.: Cardiac-resynchronization therapy in heart failure with narrow QRS complexes. N Engl J Med 2007, 357:2461–2471.

    Article  PubMed  CAS  Google Scholar 

  43. Adelstein EC, Saba S: Scar burden by myocardial perfusion imaging predicts echocardiographic response to cardiac resynchronization therapy in ischemic cardiomyopathy. Am Heart J 2007, 153:105–112.

    Article  PubMed  Google Scholar 

  44. Bleeker GB, Kaandorp TA, Lamb HJ, et al.: Effect of posterolateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy. Circulation 2006, 113:969–976.

    Article  PubMed  Google Scholar 

  45. Gradaus R, Stuckenborg V, Loher A, et al.: Diastolic filling pattern and left ventricular diameter predict response and prognosis after cardiac resynchronization therapy. Heart 2007 [Epub ahead of print].

Download references

Author information

Authors and Affiliations

  1. University of Pittsburgh, Scaife Hall 564, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    John Gorcsan

Authors
  1. John Gorcsan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John Gorcsan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gorcsan, J. Echocardiographic assessment of ventricular dyssynchrony. Curr Heart Fail Rep 5, 31–37 (2008). https://doi.org/10.1007/s11897-008-0006-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11897-008-0006-0

Keywords

Search

Navigation