Usefulness of Echocardiographic Dyssynchrony in Patients With Borderline QRS Duration to Assist With Selection for Cardiac Resynchronization Therapy
Olusegun Oyenuga, MD,
Hideyuki Hara, MD,
Hidekazu Tanaka, MD,
Han-Na Kim, MD,
Evan C. Adelstein, MD,
Samir Saba, MD,
John Gorcsan, III, MD*
University of Pittsburgh, Pittsburgh, Pennsylvania
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Figure 1 Dyssynchrony by Pulsed Doppler
(A) Pulsed Doppler sample volume in the left ventricular outflow tract with pre-ejection delay as time from onset of QRS complex to onset of flow (arrow). (B) Pulsed Doppler sample volume in the right ventricular outflow track with time from onset of QRS complex to onset of flow (arrow). Interventricular mechanical delay was the difference in this time from pre-ejection delay shown in panel A. (C) Pulsed Doppler sample volume in mitral inflow. Filling time (top arrow) was divided by R-R interval (bottom arrow).
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Figure 2 Tissue Doppler Velocity Opposing Wall Delay
Time-velocity plots from septum (yellow line) and lateral wall (blue line) using the apical 4-chamber view and demonstrating the opposing wall delay in peak velocities (arrow) during the ejection interval. AVC = aortic valve closure; AVO = aortic valve opening.
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Figure 3 Speckle Tracking Radial Strain
Time strain plots from the mid-ventricular short-axis view demonstrating anteroseptal (yellow line) to posterior wall (purple line) delay in peak strain (arrow).
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Figure 4 Receiver-Operator Characteristic Curves
Analysis of 6 dyssynchrony indexes and their association with ejection fraction response to cardiac resynchronization therapy in borderline QRS duration patients (solid green lines) and wide QRS duration patients (dashed pink lines). Area under the curve (AUC) values appear in each plot. FT/RR = filling time ratio; IVMD = interventricular mechanical delay.
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Figure 5 Ejection Fraction Response to Resynchronization Therapy
Line plots of ejection fraction values before and 8 ± 5 months after cardiac resynchronization therapy (CRT) in patients with borderline QRS duration with and without significant radial dyssynchrony.
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Figure 6 Reverse Remodeling Response to Resynchronization Therapy
*p < 0.0001. Bar graphs of mean end-systolic volume values before and 8 ± 5 months after cardiac resynchronization therapy (CRT) in patients with borderline QRS duration with and without significant radial dyssynchrony.
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