Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec 2;11(1):28.
doi: 10.1186/s44156-024-00062-z.

The implementation of speckle tracking echocardiography for cardiac resynchronization therapy optimisation. A rotational myocardial mechanics interpretation

Alexandros Stefanidis #  1 , Paraskevi Korlou #  2 , Panagiotis Margos  2 , Ignatios Ikonomidis  3 , Ioannis Paraskevaidis  4 , Konstantinos Gatzoulis  5 , Evmorfia Aivalioti  2 , Konstantinos Kostopoulos  2
Affiliations

The implementation of speckle tracking echocardiography for cardiac resynchronization therapy optimisation. A rotational myocardial mechanics interpretation

Alexandros Stefanidis et al. Echo Res Pract. .

Abstract

Background: Cardiac resynchronization therapy (CRT) has an additive therapeutic influence on left ventricular function in heart failure patients, but the underlying mechanisms through which it works are not completely explained. Our aim was to further elucidate the role of this intervention via rotational mechanics using 2D speckle tracking echocardiography (2D-STE).

Results: We investigated 46 patients (65 ± 9 years) who received CRT. All enrolled patients were assessed on admission by 2D-STE and 6 min walk test (6 min WT) and followed in the outpatient device clinic by 2D-STE (at 1 week and 6 months post-implantation) and 6 min WT (at 6 months post-implantation). On their first appointment all biventricular systems were optimised by atrioventricular delay optimisation and by changing the temporal activation of ventricular electrodes aiming to reach the highest left ventricular effective stroke volume across all activation options. A new 2D-STE based index (twist integral) targeting to assess the rotational mechanics of the whole cardiac cycle was also measured to further explain the CRT response. Twenty-two (48%) patients were responders at 6-month follow-up and most of them had dilated cardiomyopathy. The commonest selected mode that was related with the greatest left ventricular performance response was the simultaneous activation of the 2 ventricular leads (39%). The strongest predictor of CRT response was the improvement of effective stroke volume between admission and first appointment at clinic, followed by the improvement of twist integral, the absence of coronary artery disease, and the improvement of peak systolic twist.

Conclusions: Additional CRT optimisation via changing the temporal activation of ventricular electrodes is beneficial for left ventricular performance in heart failure patients. The success of biventricular pacing may also be explained by the improvement of left ventricular rotational mechanics.

Keywords: Resynchronization therapy; Rotational mechanics; Speckle tracking echocardiography.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to partcipate: The work presented has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans and informed and written consent was taken from all participants of the study. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Twist curves between responders and non-responders and methodology of the Twist Integral calculation from the algebraic summation of the green (systolic) and red (diastolic) areas integrals. The negative twist values (grey color) are represented in the formula with zero number and thus excluded from the final calculation. AVC aortic valve closure
Fig. 2
Fig. 2
Sequential change of mean TI and GLS during the study period
Fig. 3
Fig. 3
ROC curves for mean TI and GLS
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats A, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021;42(35):3427–520. - PubMed
    1. Syed Yaseen Naqvi SY, Jawaid A, Goldenberg Ι, Kutyifa V. Non-response to cardiac resynchronization therapy. Curr Heart Fail Rep 2018;15(5):315–321. - PubMed
    1. Biswas M, Sudhakar S, Nanda N, Buckberg G, Pradhan M, Roomi AU, Gorissen W, Houle H. Two- and three-dimensional speckle tracking echocardiography: clinical applications and future directions. Echocardiography. 2013;30:88–105. - PubMed
    1. Lamia B, Tanabe M, Tanaka H, Kim HK, Gorcsan J III, Pinsky M. Left ventricular systolic torsion correlates global cardiac performance during dyssynchrony and cardiac resynchronization therapy. Am J Physiol Heart Circ Physiol. 2011;300:H853–8. - PMC - PubMed
    1. Mullens W, Tang W, Grimm R. Using echocardiography in cardiac resynchronization therapy. Am Heart J. 2007;154:1011–20. - PubMed

LinkOut - more resources