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The effect of septal basal segments in the assessment of systolic dyssynchrony index
© Suinesiaputra et al; licensee BioMed Central Ltd. 2013
- Published: 30 January 2013
- Cardiac Resynchronization Therapy
- Cardiac Resynchronization Therapy Response
- Septal Base
- Intraventricular Dyssynchrony
- Regional Ejection Fraction
LV intraventricular dyssynchrony is commonly assessed by systolic dyssynchrony index (SDI), which is defined by the dispersion of time of minimum regional cavity volume. Several studies have reported conflicting results on cardiac resynchronization therapy (CRT) responses based on SDI values. In this study, we aim to characterise SDI distributions in asymptomatic patients and to analyse how particular regions affect the global SDI measurement in different patient groups.
We randomly selected 292 asymptomatic patients (EF:60.9±5.9%, LVM:135.2±36.2gr) from the MESA cohort , and 36 patients from the Sunnybrook Cardiac dataset : 12 patients with hypertrophy (EF:63.0±3.7%, LVM:176.1±86.2gr) and 24 heart failure subjects (EF:33.6±12.3%, LVM:197.1±41.0gr). Three-dimensional LV models were semi-automatically generated using dedicated software (CIM v6.0, AMRG, Auckland) from cine MRI. To register and normalise the temporal domain (0≤t≤1), LV models between frames were interpolated using smooth periodic spline method. ED frames were registered at t=0. The AHA 17-segment models were determined at ED and then propagated to all frames to get consistent regions. Segment 17 was excluded. SDI was computed by taking the standard deviation of normalised time to reach peak temporal ejection fraction (EF) from all regions.
Mean ± standard deviation of SDI values from different groups.
No septal base
5.8 ± 2.5%
4.2 ± 1.8%
6.5 ± 4.9%
3.8 ± 2.7%
11.7 ± 5.6% **
10.6 ± 5.5% **
Late regional contraction in septal base has a significant effect on the SDI values. Since SDI is measured by the dispersion of time, this effect was dominant. The delayed, as well as the increased variability, time-to-peak regional EF in these segments both seem to contribute to SDI variability. This study shows that eliminating septal base segments significantly decreased SDI values and narrowed their variation. Further validation is still needed to investigate whether this elimination protocol will better predict CRT responses.
1) The Cardiac Atlas Project, NIH - National Heart, Lung and Blood Institute (R01HL087773), and 2) Faculty Research Development Fund (FDRF), The University of Auckland.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.