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.

1st Faculty of Medicine Charles University Prague Czech Republic

Electrophysiology and Pacing Laboratory Emergency Clinical Hospital Floreasca Bucharest Romania

Integrated Heart Center Shaare Zedek Medical Center Hebrew University Faculty of Medicine Jerusalem Israel

Sanolla Nesher Israel

The Cardiovascular Research Laboratory Galilee Medical Center Nahariya Israel

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 Leviev Heart Institute Sheba Medical Center Ramat Gan Israel

The Pulmonology Unit Sheba Medical Center Ramat Gan Israel

The Sackler School of Medicine Tel Aviv University Tel Aviv Israel

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Malik A, Brito D, Vaqar S, Chhabra L. Congestive Heart Failure [Updated 2020 Jun 7]. Treasure Island, FL: StatPearls. 2020

Glikson M, Nielsen JC, Kronborg MB. et al. 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Europace. 2022;24:71–164. PubMed

Epstein AE, Dimarco JP, Ellenbogen KA. et al. 2012 ACCF/AHA/ HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2013;127:e283–352. PubMed

Auricchio A, Abraham WT. Cardiac resynchronization therapy: Current state of the art. Cost versus benefit. Circulation. 2004;109:300–7. PubMed

Leclercq C, Kass DA. Retiming the failing heart: Principles and current clinical status of cardiac resynchronization. J Am Coll Cardiol. 2002;39:194–201. PubMed

Jarcho JA. Resynchronizing ventricular contraction in heart failure. N Engl J Med. 2005;352:1594–7. PubMed

Leclercq C, Hare JM. Ventricular resynchronization: Current state of the art. Circulation. 2004;109:296–9. PubMed

Burkhardt JD, Wilkoff BL. Interventional electrophysiology and cardiac resynchronization therapy: Delivering electrical therapies for heart failure. Circulation. 2007;115:2208–20. PubMed

Daubert JC, Saxon L, Adamson PB. et al. 2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: Implant and follow-up recommendations and management. Europace. 2012;14:1236–86. PubMed

Tomassoni G. How to define cardiac resynchronization therapy response. J Innov Card Rhythm Manag. 2016;7:S1–7.

Hartlage GR, Suever JD, Clement-Guinaudeau S. et al. Prediction of response to cardiac resynchronization therapy using left ventricular pacing lead position and cardiovascular magnetic resonance derived wall motion patterns: A prospective cohort study. J Cardiovasc Magn Reson. 2015;17:57. PubMed PMC

Suffoletto MS, Dohi K, Cannesson M. et al. Novel speckle-tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy. Circulation. 2006;113:960–8. PubMed

Lim P, Buakhamsri A, Popovic ZB. et al. Longitudinal strain delay index by speckle tracking imaging: A new marker of response to cardiac resynchronization therapy. Circulation. 2008;118:1130–7. PubMed

Omar AMS, Vallabhajosyula S, Sengupta PP. Left ventricular twist and torsion: Research observations and clinical applications. Circ Cardiovasc Imaging. 2015;8:e003029. PubMed

Galli E, Leclercq C, Hubert A. et al. Role of myocardial constructive work in the identification of responders to CRT. Eur Heart J Cardiovasc Imaging. 2018;19:1010–18. PubMed

Lim P, Donal E, Lafitte S. et al. Multicentre study using strain delay index for predicting response to cardiac resynchronization therapy (MUSIC study). Eur J Heart Fail. 2011;13:984–91. PubMed

Leclercq C, Burri H, Curnis A. et al. Cardiac resynchronization therapy non-responder to responder conversion rate in the more response to cardiac resynchronization therapy with MultiPoint Pacing (MORE-CRT MPP) study: Results from phase I. Eur Heart J. 2019;40:2979–87. PubMed

Zhang X, Ha S, Wang X. et al. Speckle tracking echocardiography: Clinical applications in cardiac resynchronization therapy. Int J Clin Exp Med. 2015;8:6668–76. PubMed PMC

Saba S, Marek J, Schwartzman D. et al. Echocardiography-guided left ventricular lead placement for cardiac resynchronization therapy results of the speckle tracking assisted resynchronization therapy for electrode region trial. Circ Heart Fail. 2013;6:427–34. PubMed

Khan FZ, Virdee MS, Palmer CR. et al. Targeted left ventricular lead placement to guide cardiac resynchronization therapy: The TARGET study: A randomized, controlled trial. J Am Coll Cardiol. 2012;59:1509–18. PubMed

Salden OAE, Zweerink A, Wouters P. et al. The value of septal rebound stretch analysis for the prediction of volumetric response to cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging. 2021;22:37–45. PubMed

Ross S, Nestaas E, Kongsgaard E. et al. Septal contraction predicts acute haemodynamic improvement and paced QRS width reduction in cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging. 2020;21:845–52. PubMed

DeVecchi F, Facchini E, Degiovanni A. et al. Acute contractile recovery extent during biventricular pacing is not associated with follow-up in patients undergoing resynchronization. Int J Cardiol Heart Vasc. 2016;11:66–73. PubMed PMC