Emerging Role of Three-Dimensional Speckle Tracking Strain for Accurate Quantification of Left Ventricular Dyssynchrony

作者：Tanaka Hidekazu^*; Tatsumi Kazuhiro; Matsumoto Kensuke; Kawai Hiroya; Hirata Ken ichi

来源：Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques, 2013, 30(9): E292-E294.

DOI：10.1111/echo.12280

• echocardiography
• heart failure
• left bundle branch block
• three-dimensional echocardiography
• strain

A case was 53-year-old female with dilated-phase hypertrophic cardiomyopathy. She was classified as New York Heart Association functional class III heart failure despite receiving optimal medical therapy. The electrocardiogram taken showed intraventricular conduction delay with a QRS width of 194msec. The left ventricular (LV) end-diastolic and systolic volumes, and ejection fraction (EF) were 101mL, 68mL, and 32%, respectively. The patient showed no significant mechanical LV dyssynchrony as evidenced by two-dimensional (2D) speckle tracking radial strain, which is defined as the time difference between anterior-septum and posterior wall, of 105msec (%26lt;130msec). Three-dimensional (3D) speckle tracking radial strain was performed for more detailed LV mechanical dyssynchrony analysis. An especially important finding for 3D speckle tracking radial strain analysis was that the average time-to-peak strain of 5 septum segments at 3 different LV levels (basal-anterior-septum, basal-septum, mid-anterior-septum, mid-septum, apical-septum) was significantly shorter than that of 5 posterolateral segments at 3 different LV levels (basal-posterior, basal-lateral, mid-posterior, mid-lateral, apical-lateral). This time difference between septum and posterolateral wall was 216msec (204msec vs. 420msec), which was considered to indicate significant LV mechanical dyssynchrony (130msec). 12months after cardiac resynchronization therapy (CRT), EF had improved to 47%, while end-systolic and diastolic volumes had decreased to 88mL and 47mL, respectively, so that the patient was classified as a responder. In conclusions, a newly developed 3D speckle tracking strain can provide a comprehensive evaluation of true LV mechanical dyssynchrony from pyramidal 3D data sets acquired in the same beat, thus yielding more accurate information than previously possible with the 2D speckle tracking system. %26lt;br%26gt;Mini-Abstract %26lt;br%26gt;A 53-year-old female with QRS of 194msec, and ejection fraction (EF) of 32% refereed for cardiac resynchronization therapy (CRT). No significant dyssynchrony was observed as evidenced by two-dimensional (2D) speckle tracking radial strain (time difference between anterior-septum and posterior wall of 105%26lt;130msec). However, three-dimensional (3D) speckle tracking radial strain revealed that the average time-to-peak strain of 5 septum segments at 3 different levels was significantly shorter than that of 5 posterolateral segments at 3 different levels (216%26gt;130msec). EF had improved to 47% 12months after CRT. A newly developed 3D speckle tracking can provide a comprehensive evaluation of true dyssynchrony.

• 出版日期2013-10