Comparison of CMR DENSE strain imaging and 2D speckle tracking echocardiography for cardiac resynchronization therapy (CRT) response
© Gonzalez et al. 2016
Published: 27 January 2016
Considering that nonresponse rates to cardiac resynchronization therapy (CRT) are typically 35-50%, assessment of the cardiac substrate for CRT with cardiac imaging could be very helpful for many patients with heart failure referred for this therapy. We have previously shown that CMR assessment of dyssynchrony using displacement encoding with stimulated echoes (DENSE) is strongly associated with CRT response; however, there has not yet been a direct comparison between this CMR methodology and more commonly used 2D speckle tracking echocardiography (STE) dyssynchrony parameters.
We imaged 60 patients with CMR DENSE and 2D STE. STE was performed using commercial ultrasound by acquiring digital routine greyscale 2-D cine loops from 3 consecutive beats obtained at the end of expiration from standard apical views (2,3 and 4-chamber) and in basal and mid-cavity short-axis slices. Differences in time to peak (TTP) radial, transverse and longitudinal strain in opposing walls were determined using standard methods. CMR spiral cine DENSE was performed using a 1.5 T MR scanner. CMR dyssynchrony was determined using the circumferential uniformity estimate with singular value decomposition (CURE-SVD), as we have previously described. We examined associations between these dyssynchrony measures and the extent of LV reverse remodeling based on the change in LV end-systolic volume (LVESV) 6 months after CRT. Linear regression analysis was performed using SAS 9.4.
CMR assessment of dyssynchrony with CMR DENSE CURE-SVD is strongly associated with response to CRT based on LVRR criteria, but STE parameters were not associated with the extent of LVRR after CRT in this cohort. Furthermore, there were minimal associations between STE delays in TTP strain and CURE-SVD determined with CMR DENSE. Thus, CMR strain analysis is superior to STE for assessment of the likelihood of CRT response.
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