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. 2021 Jan 21;18(3):926.
doi: 10.3390/ijerph18030926.

Regional Strain Pattern Index-A Novel Technique to Predict CRT Response

Michał Orszulak  1 , Artur Filipecki  1 , Wojciech Wróbel  1 , Adrianna Berger-Kucza  1 , Witold Orszulak  1 , Dagmara Urbańczyk-Swić  1 , Wojciech Kwaśniewski  1 , Edyta Płońska-Gościniak  2 , Katarzyna Mizia-Stec  1
Affiliations

Regional Strain Pattern Index-A Novel Technique to Predict CRT Response

Michał Orszulak et al. Int J Environ Res Public Health. .

Abstract

Background: Cardiac resynchronization therapy (CRT) improves outcome in patients with heart failure (HF) however approximately 30% of patients still remain non-responsive. We propose a novel index-Regional Strain Pattern Index (RSPI)-to prospectively evaluate response to CRT.

Methods: Echocardiography was performed in 49 patients with HF (66.5 ± 10 years, LVEF 24.9 ± 6.4%, QRS width 173.1 ± 19.1 ms) two times: before CRT implantation and 15 ± 7 months after. At baseline, dyssynchrony was assessed including RSPI and strain pattern. RSPI was calculated from all three apical views across 12 segments as the sum of dyssynchronous components. From every apical view, presence of four components were assessed: (1) contraction of the early-activated wall; (2) prestretching of the late activated wall; (3) contraction of the early-activated wall in the first 70% of the systolic ejection phase; (4) peak contraction of the late-activated wall after aortic valve closure. Each component scored 1 point, thus the maximum was 12 points.

Results: Responders reached higher mean RSPI values than non-responders (5.86 ± 2.9 vs. 4.08 ± 2.4; p = 0.044). In logistic regression analysis value of RSPI ≥ 7 points was a predictor of favorable CRT effect (OR: 12; 95% CI = 1.33-108.17; p = 0.004).

Conclusions: RSPI could be a valuable predictor of positive outcome in HF patients treated with CRT.

Keywords: RSPI; cardiac resynchronization therapy; dyssynchrony; heart failure; strain pattern.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Components of Regional Strain Pattern Index (RSPI). Illustration of the four components of RSPI based on an analysis of the 4-chamber apical view strain curves: (1) the early contraction of the early-activated wall (light blue line; light blue arrow); (2) the prestretching of the opposing, late-activated wall (blue line, yellow arrow); (3) the contraction of the early-activated wall occurs in the first 70% of the systolic ejection phase and (4) the peak contraction of the late-activated wall occurs after aortic valve closure (red line, red arrow). AVC indicates aortic valve closure.
Figure 2
Figure 2
RSPI calculation: 4-chamber view. In 4-chamber view patient reached 3 points: early contraction of the midventricular segment (light blue line; light blue arrow) in the interventricular septum [1 point] but peak contraction slightly exceeds 70% of the systolic ejection phase [0 point]; early prestretching of the basal segment (red line; yellow arrow) in the lateral wall [1 point] with the peak contraction (red arrow) after aortic valve closure [1 point].
Figure 3
Figure 3
RSPI calculation: 2-chamber view. In 2-chamber view patient reached 2 point: the basal segment in the anterior wall exhibits contraction movement (red line; light blue arrow) [1 point], but it does not fulfill criterion of early 70% of the ejection phase [0 point]. The basal segment in the inferior wall (yellow line) does not show early stretching [0 point] but peak contraction occurs after aortic valve closure (red arrow) [1 point].
Figure 4
Figure 4
RSPI calculation: 3-chamber view. In 3-chamber view patient reached 3 points: early contraction of the basal segment (red line; light blue arrow) in the anteroseptal wall [1 point] but peak contraction exceeds 70% of the systolic ejection phase [0 point]; early prestretching of the basal segment (yellow line; yellow arrow) in the posterior wall [1 point] with the peak contraction (red arrow) after aortic valve closure [1 point].
Figure 5
Figure 5
Receiver operating characteristic curves for Regional Strain Pattern Index (RSPI) in prediction of Cardiac Resynchronization Therapy (CRT) response (AUC = area under the curve).
See this image and copyright information in PMC

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