Additional value of three-dimensional echocardiography in patients with cardiac resynchronization therapy

Antoine Deplagne, Pierre Bordachar, Patricia Reant, Michel Montaudon, Sylvain Reuter, Julien Laborderie, Pierre Dos Santos, Raymond Roudaut, Pierre Jais, Michel Haissaguerre, François Laurent, Jacques Clementy, Stéphane Lafitte
Archives of Cardiovascular Diseases 2009, 102 (6-7): 497-508

BACKGROUND: There is no gold standard technique for quantification of ventricular dyssynchrony.

AIM: To investigate whether additional real-time three-dimensional morphologic assessment of ventricular dyssynchrony affects response after biventricular pacing.

METHODS: Forty-one patients with severe heart failure were implanted with a biventricular pacing device and underwent two-dimensional (time dispersion of 12 left ventricular electromechanical delays) and three-dimensional echocardiographic assessment of ventricular dyssynchrony (dispersion of time to minimum regional volume for 16 left ventricular segments), before implantation, 2 days postimplantation with optimization of the pacing interventricular delay and 6 months postimplantation.

RESULTS: Individual optimization of sequential biventricular pacing based on three-dimensional ventricular dyssynchrony provided more improvement (p<0.05) in left ventricular ejection fraction and cardiac output than simultaneous biventricular pacing. During the different configurations of sequential biventricular pacing, the changes in three-dimensional ventricular dyssynchrony were highly correlated with those of cardiac output (r=-0.67, p<0.001) and ejection fraction (r=-0.68, p<0.001). The correlations between two-dimensional ventricular dyssynchrony and cardiac output or ejection fraction were significant but less (r=-0.60, p<0.01 and r=-0.56, p<0.05, respectively). After 6 months, 76% of patients were considered responders (10% decrease in end-systolic volume). Before implantation, we observed a significant difference between responders and non-responders in terms of three-dimensional (p<0.05) - but not two-dimensional - ventricular dyssynchrony.

CONCLUSION: This prospective study demonstrated the additional value of three-dimensional assessment of ventricular dyssynchrony in predicting response after biventricular pacing and optimizing the pacing configuration.

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