This Article Figures Only Full Text Full Text (PDF) View Related Keeping an Eye on Imaging on CVN Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Google Scholar Articles by Sonne, C. Articles by Lang, R. M. PubMed Articles by Sonne, C. Articles by Lang, R. M. Related Collections Related Articles

Real-Time 3-Dimensional Echocardiographic Assessment of Left Ventricular Dyssynchrony

Pitfalls in Patients With Dilated Cardiomyopathy

Carolin Sonne, MD^_*, Lissa Sugeng, MD^_*, Masaaki Takeuchi, MD^_*,, Lynn Weinert, BS^_*, Roderick Childers, MD^_*, Nozomi Watanabe, MD, Kiyoshi Yoshida, MD, PhD, Victor Mor-Avi, PhD^_*, Roberto M. Lang, MD^_*,_*

^_* University of Chicago Medical Center, Chicago, Illinois
University of Occupational and Environmental Health, Kitakyushu, Japan
Kawasaki Medical School, Kurashiki, Japan

^_* Reprint requests and correspondence: Dr. Roberto M. Lang, University of Chicago Medical Center, 5841 South Maryland Avenue, MC5084, Chicago, Illinois 60637 (Email: rlang{at}bsd.uchicago.edu).

Objectives: This study sought to establish normal values for real-time 3-dimensional echocardiography (RT3DE)–derived left ventricular (LV) dyssynchrony index (LVDI) and determine its age dependency, and to compare dyssynchrony in patients with normal LV function and patients with dilated cardiomyopathy (DCM), with and without left bundle branch block (LBBB).

Background: Cardiac resynchronization therapy is known to be ineffective in one-third of patients with heart failure, highlighting the need for alternative techniques to assess LV dyssynchrony.

Methods: Datasets from RT3DE were analyzed to calculate LVDI using 16- and 17-segment models. First, 135 normal subjects were studied to establish LVDI abnormality threshold (mean + 2 SD) and to study the relationship with age. Then, 3 groups of patients (N = 16 each: DCM with and without LBBB, normal LV function with LBBB) were compared with 50 age-matched normal control subjects.

Results: In normal subjects, the 16-segment model resulted in a lower LVDI abnormality threshold than the 17-segment model (4.0% vs. 4.5%). In patients with normal LV function, LVDI was significantly lower than in those with DCM, irrespective of LBBB. Although LBBB resulted in a nearly 2-fold increase in LVDI in patients with normal LV function, its effects were nonsignificant in DCM. All patients with DCM and ejection fraction <35% had abnormally high LVDI, likely as a result of low signal-to-noise ratio in low-amplitude regional volume curves hampering accurate determination of regional ejection time.

Conclusions: Normal values established in this study resulted in indiscriminate diagnosis of abnormal dyssynchrony in all patients with reduced LV function. The value of RT3DE-derived LVDI in the evaluation of dyssynchrony in patients with reduced LV function needs to be critically reassessed because of the inability to accurately detect end-ejection in low-amplitude regional volume curves. Alternative indices of dyssynchrony need to be developed to address this limitation.

Key Words: left ventricular dyssynchrony • 3-dimensional echocardiography • heart failure

Abbreviations and Acronyms   CRT = cardiac resynchronization therapy   DCM = dilated cardiomyopathy   ECG = electrocardiogram/electrocardiography   EDV = end-diastolic volume   EF = ejection fraction   ESV = end-systolic volume   HF = heart failure   LBBB = left bundle branch block   LV = left ventricle/ventricular   LVDI = left ventricular dyssynchrony index   LVEF = left ventricular ejection fraction   RT3DE = real-time 3-dimensional echocardiography   TDI = Tissue Doppler imaging

Related Articles

3-Dimensional Echocardiographic Assessment of Left Ventricular Dyssynchrony: An Alternative Viewpoint

Mark Monaghan, Jeroen Bax, Andreas Franke, Otto Kamp, Harald Kuehl, Petros Nihoyannopoulos, and Folkert TenCate
J. Am. Coll. Cardiol. Img. 2009 2: 1334-1335. [Full Text] [PDF]

This article has been cited by other articles:

				M. Monaghan, J. Bax, A. Franke, O. Kamp, H. Kuehl, P. Nihoyannopoulos, and F. TenCate 3-Dimensional Echocardiographic Assessment of Left Ventricular Dyssynchrony: An Alternative Viewpoint J. Am. Coll. Cardiol. Img., November 1, 2009; 2(11): 1334 - 1335. [Full Text] [PDF]

				V. Mor-Avi and R. M. Lang Reply J. Am. Coll. Cardiol. Img., November 1, 2009; 2(11): 1335 - 1336. [Full Text] [PDF]

				S. F. Nagueh Imaging Mechanical Dyssynchrony With 3-Dimensional Echocardiography: A Promise Still to Be Fulfilled J. Am. Coll. Cardiol. Img., July 1, 2009; 2(7): 813 - 815. [Full Text] [PDF]