Measures of Left Ventricular Dyssynchrony and the Correlation to Clinical and Echocardiographic Response After Cardiac Resynchronization Therapy

There is still no standardized measure of left ventricular (LV) dyssynchrony or definition of response in candidates of cardiac resynchronization therapy (CRT). Recipients of CRT underwent echocardiographic assessment of LV dyssynchrony before and immediately after implantation of a CRT device. Patients were followed for 6 months postimplantation. A total of 44 patients (64 ± 12 years, 30 men, and 26 with ischemic cardiomyopathy) were included in this analysis. There was a significant decrease in both radial (304 ± 137 vs 121 ± 85 ms, p <0.001) and longitudinal (143 ± 104 vs 95 ± 43 ms, p = 0.02) measures of LV dyssynchrony immediately after CRT. The immediate post-CRT change in radial (r = -0.43, p = 0.015) but not longitudinal (r = -0.09, p = 0.61) LV dyssynchrony correlated with a significant improvement in the physical component of the quality-of-life score 6 months after CRT. Although a higher baseline longitudinal (p = 0.05) or radial (p = 0.025) LV dyssynchrony predicted a ≥1 improvement in New York Heart Association classification of heart failure 6 months after CRT, acute changes in neither radial (p = 0.71) nor longitudinal (p = 0.89) LV dyssynchrony were predictive of any improved echocardiographic outcomes in follow-up. Concordance between clinical and echocardiographic response to CRT was documented in 72% of patients. In conclusion, both longitudinal and radial measures of LV dyssynchrony improve after CRT. The change in longitudinal but not radial measures of LV dyssynchrony correlates with improved physical quality-of-life score in intermediate term follow-up.