Background: Approximately 30% of patients do not respond to implantation of Cardiac Resynchronization Therapy - Defibrillators (CRT-D). The aim of this study was to investigate the potential for cardiac strain speckle tracking to optimize the performance of CRT-D in non-responding patients. Methods: 30 patients not responding to Cardiac Resynchronization Therapy-Defibrillators after 3 months were randomly divided into control and intervention groups. Atrioventricular interval was adjusted so that E and A waves did not overlap, the interventricular interval was subsequently optimized to yield maximum improvement of the sum of longitudinal+radial+circumferential strains. The left ventricular ejection fraction (LVEF) and NYHA improvement 3 months after optimization were evaluated and use of other strain combinations assessed. Results: A significant correlation between the (combined) strain change and LVEF improvement was detected (p<0.01). 75% of patients with non-ischemic etiology of heart failure who did not respond to the original CRT-D reacted favorably with significant LVEF and NYHA improvement. The area strain was the best predictor of LVEF/NYHA improvement in those patients. No significant improvement was recorded in patients with ischemic etiology. Conclusions: AV and VV optimization based on speckle tracking is a very promising method potentially leading to a significant improvement of the outcome of CRT-D, especially in patients with non-ischemic etiology of heart failure.

Department of Cardiovascular Diseases University Hospital in Ostrava 17 listopadu 1790 708 00 Ostrava Czech Republic

Department of Cardiovascular Diseases University Hospital in Ostrava 17 listopadu 1790 708 00 Ostrava Czech Republic Faculty of Medicine Masaryk University Brno Kamenice 5 625 00 Brno Czech Republic

Faculty of Medicine Masaryk University Brno Kamenice 5 625 00 Brno Czech Republic Clinic of Internal Medicine Cardiology University Hospital Brno 625 00 Czech Republic

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