Left and right ventricular longitudinal strains are predictors of reverse remodeling after cardiac resynchronization therapy

AIM To identify the strain echocardiographic parameters for predicting LV reverse remodeling after cardiac resynchronization therapy (CRT). METHODSFifty consecutive patients with heart failure for implantation of a biventricular pacemaker were enrolled. Echocardiographic and clinical data were collected at baseline and 6 months after implantation, including left ventricular systolic longitudinal strain (LVSLS) and right ventricular systolic longitudinal strain (RVSLS). Patients were grouped according to echocardiographic response. Multivariable analysis was performed on significant parameters on the univariate analysis. Sensitivity and specificity of the best performing cutoff value for the parameters was determined using receiver operating characteristic curve analysis. These echocardiographic parameters were combined to predict LV reverse remodeling after CRT. RESULTSBaseline echocardiographic indexes of left ventricular systolic longitudinal strain (LVSLS) and right ventricular systolic longitudinal strain (RVSLS) were significantly more impaired in nonresponders vs. responders to CRT (P<0.01). Multiple logistic analysis identified LVSLS ［OR 3.45 CI(2.47-10.86), P<0.01］, RVSLS ［OR 3.01 CI (1.98-4.66), P<0.0］ as the independent predictor of reverse remodeling after CRT. Cut-off values were defined as LVSLS>9.7% with 90% sensitivity, 42% specificity and 72% accuracy, (AUC=0.22, P<0.01) and RVSLS>16.8% with 87% sensitivity 53% specificity and 74% accuracy (AUC=0.703, P<0.01). Patients with baseline LVSLS>9.7% and RVSLS>16.8% were named both-responder. Others were named non-both-responder. Combined LVSLS and RVSLS predicted CRT response with 84% sensitivity, 68% specificity and 78% accuracy, which was significantly better than either technique alone (AUC=0.798, P<0.01). CONCLUSIONLeft and right ventricular systolic function are associated with LV reverse remodeling after CRT. The combined echocardiographic parameters of left and right ventricular longitudinal strain predict the outcomes more accurately than a single echocardiographic parameter.