Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy: Results of the Speckle Tracking and Resynchronization (STAR) study

Hidekazu Tanaka, Hans Joachim Nesser, Thomas Buck, Olusegun Oyenuga, Rolf Alexander Jánosi, Siegmund Winter, Samir Saba, John Gorcsan

Research output: Contribution to journalArticle

201 Scopus citations

Abstract

Aims The Speckle Tracking and Resynchronization (STAR) study used a prospective multi-centre design to test the hypothesis that speckle-tracking echocardiography can predict response to cardiac resynchronization therapy (CRT).Methods and resultsWe studied 132 consecutive CRT patients with class III and IV heart failure, ejection fraction (EF) ≤35, and QRS ≥120 ms from three international centres. Baseline dyssynchrony was evaluated by four speckle tracking strain methods; radial, circumferential, transverse, and longitudinal (≥130 ms opposing wall delay for each). Pre-specified outcome variables were EF response and three serious long-term events: death, transplant, or left ventricular assist device. Of 120 patients (91) with baseline dyssynchrony data, both short-axis radial strain and transverse strain from apical views were associated with favourable EF response 7 ± 4 months and long-term outcome over 3.5 years (P < 0.01). Radial strain had the highest sensitivity at 86 for predicting EF response with a specificity of 67. Serious long-term unfavourable events occurred in 20 patients after CRT, and happened three times more frequently in those who lacked baseline radial or transverse dyssynchrony than in patients with dyssynchrony (P < 0.01). Patients who lacked both radial and transverse dyssynchrony had unfavourable clinical events occur in 53, in contrast to events occurring in 12 if baseline dyssynchrony was present (P < 0.01). Circumferential and longitudinal strains predicted response when dyssynchrony was detected, but failed to identify dyssynchrony in one-third of patients who responded to CRT. Conclusion Dyssynchrony by speckle-tracking echocardiography using radial and transverse strains is associated with EF response and long-term outcome following CRT.

Original languageEnglish
Pages (from-to)1690-1700
Number of pages11
JournalEuropean heart journal
Volume31
Issue number14
DOIs
StatePublished - Jul 1 2010
Externally publishedYes

Keywords

  • Echocardiography
  • Heart failure
  • Pacing therapy

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