PMID- 21232699
OWN - NLM
STAT- MEDLINE
DCOM- 20110502
LR  - 20161125
IS  - 1876-7591 (Electronic)
IS  - 1876-7591 (Linking)
VI  - 4
IP  - 1
DP  - 2011 Jan
TI  - Real-time 3D echo in patient selection for cardiac resynchronization therapy.
PG  - 16-26
LID - 10.1016/j.jcmg.2010.09.021 [doi]
AB  - OBJECTIVES: this study investigated the use of 3-dimensional (3D) echo in 
      quantifying left ventricular mechanical dyssynchrony (LVMD), its interhospital 
      agreement, and potential impact on patient selection. BACKGROUND: assessment of 
      LVMD has been proposed as an improvement on conventional criteria in selecting 
      patients for cardiac resynchronization therapy (CRT). Three-dimensional echo 
      offers a reproducible assessment of left ventricular (LV) structure, function, 
      and LVMD and may be useful in selecting patients for this intervention. METHODS: 
      we studied 187 patients at 2 institutions. Three-dimensional data from baseline 
      and longest follow-up were quantified for volume, left ventricular ejection 
      fraction (LVEF), and systolic dyssynchrony index (SDI). New York Heart 
      Association (NYHA) functional class was assessed independently. Several outcomes 
      from CRT were considered: 1) reduction in NYHA functional class; 2) 20% relative 
      increase in LVEF; and 3) 15% reduction in LV end-systolic volume. Sixty-two cases 
      were shared between institutions to analyze interhospital agreement. RESULTS: 
      there was excellent interhospital agreement for 3D-derived LV end-diastolic and 
      end- systolic volumes, EF, and SDI (variability: 2.9%, 1%, 7.1%, and 7.6%, 
      respectively). Reduction in NYHA functional class was found in 78.9% of patients. 
      Relative improvement in LVEF of 20% was found in 68% of patients, but significant 
      reduction in LV end-systolic volume was found in only 41.5%. The QRS duration was 
      not predictive of any of the measures of outcome (area under the curve [AUC]: 
      0.52, 0.58, and 0.57 for NYHA functional class, LVEF, and LV end-systolic 
      volume), whereas SDI was highly predictive of improvement in these parameters 
      (AUC: 0.79, 0.86, and 0.66, respectively). For patients not fulfilling 
      traditional selection criteria (atrial fibrillation, QRS duration <120 ms, or 
      undergoing device upgrade), SDI had similar predictive value. A cutoff of 10.4% 
      for SDI was found to have the highest accuracy for predicting improvement 
      following CRT. CONCLUSIONS: the LVMD quantification by 3D echo is reproducible 
      between centers. SDI was an excellent predictor of response to CRT in this 
      selected patient cohort and may be valuable in identifying a target population 
      for CRT irrespective of QRS morphology and duration.
CI  - 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All 
      rights reserved.
FAU - Kapetanakis, Stamatis
AU  - Kapetanakis S
AD  - Department of Cardiology, King's College Hospital, Denmark Hill, London, United 
      Kingdom.
FAU - Bhan, Amit
AU  - Bhan A
FAU - Murgatroyd, Francis
AU  - Murgatroyd F
FAU - Kearney, Mark T
AU  - Kearney MT
FAU - Gall, Nicholas
AU  - Gall N
FAU - Zhang, Qing
AU  - Zhang Q
FAU - Yu, Cheuk-Man
AU  - Yu CM
FAU - Monaghan, Mark J
AU  - Monaghan MJ
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - JACC Cardiovasc Imaging
JT  - JACC. Cardiovascular imaging
JID - 101467978
SB  - IM
MH  - Aged
MH  - *Cardiac Resynchronization Therapy
MH  - Defibrillators, Implantable
MH  - *Echocardiography, Three-Dimensional
MH  - Female
MH  - Heart Failure/diagnostic imaging/physiopathology/*therapy
MH  - Humans
MH  - Male
MH  - Observer Variation
MH  - Pacemaker, Artificial
MH  - Patient Selection
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/*diagnostic imaging
EDAT- 2011/01/15 06:00
MHDA- 2011/05/03 06:00
CRDT- 2011/01/15 06:00
PHST- 2010/06/07 00:00 [received]
PHST- 2010/09/14 00:00 [revised]
PHST- 2010/09/16 00:00 [accepted]
PHST- 2011/01/15 06:00 [entrez]
PHST- 2011/01/15 06:00 [pubmed]
PHST- 2011/05/03 06:00 [medline]
AID - S1936-878X(10)00737-0 [pii]
AID - 10.1016/j.jcmg.2010.09.021 [doi]
PST - ppublish
SO  - JACC Cardiovasc Imaging. 2011 Jan;4(1):16-26. doi: 10.1016/j.jcmg.2010.09.021.