Quantification of Left Ventricular Asynchrony Throughout the Whole Cardiac Cycle with a Computed Algorithm: Application for Optimizing Resynchronization Therapy

  1. E. SILVA B. Eng. ,
  2. M. SITGES Ph.D.,
  3. L. MONT Ph.D.,
  4. V. DELGADO M.D.,
  5. D. TAMBORERO B. Eng. ,
  6. B. VIDAL Ph.D.,
  7. M. GODOY M.D.,
  8. S. POYATOS R.N.,
  9. C. PARE Ph.D.,
  10. M. AZQUETA M.D.,
  11. J. BRUGADA Ph.D.

Article first published online: 22 JUN 2009

DOI: 10.1111/j.1540-8167.2009.01507.x

Issue

Journal of Cardiovascular Electrophysiology

Journal of Cardiovascular Electrophysiology

Volume 20, Issue 10, pages 1130–1136, October 2009

Additional Information

How to Cite

SILVA, E., SITGES, M., MONT, L., DELGADO, V., TAMBORERO, D., VIDAL, B., GODOY, M., POYATOS, S., PARE, C., AZQUETA, M. and BRUGADA, J. (2009), Quantification of Left Ventricular Asynchrony Throughout the Whole Cardiac Cycle with a Computed Algorithm: Application for Optimizing Resynchronization Therapy. Journal of Cardiovascular Electrophysiology, 20: 1130–1136. doi: 10.1111/j.1540-8167.2009.01507.x

Author Information

  1. Thorax Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain ∧IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer

*Address for correspondence: Marta Sitges, M.D., Ph.D., Thorax Clinic Institute, Hospital Clínic, Villarroel 136, 08036 Barcelona, Spain. Fax: 34-93-451-41-48; E-mail: msitges@clinic.ub.es

Publication History

  1. Issue published online: 6 OCT 2009
  2. Article first published online: 22 JUN 2009
  3. Manuscript received 17 December 2008; Revised manuscript received 1 April 2009; Accepted for publication 6 April 2009.

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Keywords:

  • heart failure;
  • resynchronization;
  • dyssynchrony;
  • echocardiography;
  • tissue Doppler imaging

Introduction: Measurement of left ventricular (LV) asynchrony is usually determined on single time points from spectral tissue Doppler imaging (TDI) scans that are frequently difficult to identify or not representative of the whole cardiac cycle. Our aim was to validate a new asynchrony index that evaluates the motion of the LV walls throughout the whole cardiac cycle.

Methods and Results: Ten healthy volunteers and 50 patients undergoing cardiac resynchronization therapy (CRT) were studied with TDI. Wall displacement tracings from the septal and lateral LV walls were analyzed. Cross-correlation was calculated and 2 indices were obtained to assess LV asynchrony: the time delay and the superposition index (SI) between wall displacements. These results were compared between healthy volunteers and CRT patients, and between responders and nonresponders to CRT. Also, the optimal interventricular (VV) interval was based upon the best matching level. Volunteers showed lower asynchrony indices (83 ± 2% SI, 17 ± 8 ms time delay) as compared with CRT patients (63 ± 15% SI, 73 ± 60 ms time delay, P < 0.05). Responders also had more LV dyssynchrony than nonresponders (58 ± 15% SI and 92 ± 66 ms vs 68 ± 12% and 48 ± 34 ms, P < 0.05). The optimum VV interval selected by the computed algorithm showed an excellent concordance (Kappa = 0.90, P < 0.05) with that determined by other validated methods for optimizing the programming of CRT devices.

Conclusions: This approach allows measurement of LV intraventricular asynchrony throughout the cardiac cycle, being useful to determine the optimum VV interval and to select candidates for CRT.

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