Comparison of Speckle Tracking Echocardiography During Different Pacing Modalities for Cardiac Resynchronization Therapy Response Prediction
Authors: Tejman-Yarden Shai ,   The Edmond J. Safra International Congenital Heart Center, Sheba Medical Center, Ramat Gan, Israel,   The Engineering Medical Research Laboratory, Sheba Medical Center, Ramat Gan, Israel,   The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, Barzilai Dor Hadida ,   The Engineering Medical Research Laboratory, Sheba Medical Center, Ramat Gan, Israel,   First Faculty of Medicine, Charles University, Prague, Czech Republic, Ertracht Offir ,   The Cardiovascular Research Laboratory, Galilee Medical Center, Nahariya, Israel, Bachner-Heinenzon Noa ,   Sanolla, Nesher, Israel, Bogdan Stephan ,   Electrophysiology and Pacing Laboratory Emergency Clinical Hospital Floreasca, Bucharest, Romania, Katz Uriel ,   The Edmond J. Safra International Congenital Heart Center, Sheba Medical Center, Ramat Gan, Israel,   The Engineering Medical Research Laboratory, Sheba Medical Center, Ramat Gan, Israel,   The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, Chatterji Sumit ,   The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,   The Pulmonology Unit, Sheba Medical Center, Ramat Gan, Israel, Dray Efrat Mazor ,   The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,   The Leviev Heart Institute, Sheba Medical Center, Ramat Gan, Israel, Bolkier Yoav ,   The Edmond J. Safra International Congenital Heart Center, Sheba Medical Center, Ramat Gan, Israel,   The Engineering Medical Research Laboratory, Sheba Medical Center, Ramat Gan, Israel,   The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, Glikson Michael ,   Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel, Beinart Roy ,   The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,   The Leviev Heart Institute, Sheba Medical Center, Ramat Gan, Israel
Published: July 2022

Background: The aim of this study was to evaluate left ventricular mechanical activation pattern by speckle tracking echocardiography (STE) as a predictor of response to cardiac resynchronization therapy (CRT) in patients with heart failure. Methods: Echocardiography was performed during no pacing, right ventricular pacing (RVP), biventricular pacing (BVP) and multipolar pacing (MPP) immediately after CRT implantation in 16 patients at a single centre. Seven patients were diagnosed as responders and 9 patients as non-responders after 6 months of standard CRT pacing. All had adequate short axis views, and 1 CRT responder and 2 CRT non-responders had limited longitudinal views. Results: Longitudinal and circumferential global strain (GS) and global strain rate (GSR) or their change analysis, did not yield any CRT response prediction. However, the longitudinal BVP/RVP GS ratio was significantly higher in the responder group (1.32 ± 0.2%, 2.0 ± 0.4% and 1.9 ± 0.4%), compared with the non-responder group (1.06 ± 0.2%, 1.1 ± 0.4% and 1.2 ± 0.4%) in the apical two-chamber, APLAX and four-chamber views, respectively. Similarly, the longitudinal BVP/RVP GSR at active systolic phase (GSRs) was significantly higher in the responder group (1.9 ± 0.9% and 1.7 ± 0.4%) compared with the non-responder group (1.0 ± 0.4% and 1.1 ± 0.2%) in the apical APLAX and four-chamber views, respectively. Measurements of the strain delay index showed predictive power regarding CRT response in non-paced patients. Conclusion: Post implantation, longitudinal BVP/RVP GS and GSRs ratios of 1.4% and above may be useful as a CRT response prediction tool. Furthermore, our findings support the usefulness of strain delay index prior to CRT implantation in non-paced patients.