The value of global myocardial index to detect cardiac dyssynchrony in patients with non-ischemic dilated cardiomyopathy

The value of global myocardial index to detect cardiac dyssynchrony in patients with non-ischemic dilated cardiomyopathy

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Title: The value of global myocardial index to detect cardiac dyssynchrony in patients with non-ischemic dilated cardiomyopathy
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Article_Title: The value of global myocardial index to detect cardiac dyssynchrony in patients with non-ischemic dilated cardiomyopathy
Authors: Mihaela Nicolin, Cristian Mornos, Adina Ionac, Aniko Mornos, Sorin Pescariu, Stefan-Iosif Dragulescu
Affiliation: 1 “Victor Babes” Timisoara University of Medicine and Pharmacy, Timisoara, Romania
2MD, PhD, “Victor Babes” Timisoara University of Medicine and Pharmacy, Timisoara, Romania
3MD, PhD, “Victor Babes” Timisoara University of Medicine and Pharmacy, Timisoara, Romania
4MD, “Victor Babes” Timisoara University of Medicine and Pharmacy, Timisoara, Romania
5MD, PhD, “Victor Babes” Timisoara University of Medicine and Pharmacy, Timisoara, Romania
6MD, Prof, PhD, FESC, “Victor Babes” Timisoara University of Medicine and Pharmacy, Timisoara, Romania
Abstract: A variety of parameters has been proposed in left ventricular (LV) asynchrony evaluation. Echocardiography was performed in 95 patients with non-ischemic dilated cardiomyopathy (DCM). Global myocardial index (GMI) and time to peak systolic velocity (Ts) was measured from the beginning of the QRS complex to the peak myocardial systolic velocity. Absolute difference in Ts between any two of the four basal LV segments, absolute difference in Ts between any two of the six basal LV segments, absolute difference in Ts between any 2 of the 12 (6 basal and 6 mid) LV segments, and standard deviation of Ts of the 12 (6 basal and 6 mid) LV segments were derived. A composite score was calculated combining the above four dyssynchrony parameters. All GMI differed significantly among dyssynchrony groups. The area under ROC-curve to detect patients with all four criteria of dyssynchrony was 0.94 for GMI (100% sensitivity, 90% specificity). In conclusion, GMI could be used as simple index to detect LV desynchronization in DCM.
Keywords: Cardiac dyssynchrony, Global myocardial index, Tissue Doppler Imaging
References: Abraham WT, Fisher WG, Smith AL, et al. for the MIRACLE study group. Cardiac resynchronization in chronic heart failure N Engl J Med, 2002; 346: 1845-53
Bax JJ, Bleeker GB, Marwick TH, Molhoek SG, Boersma E, Steendijk P, van der Wall EE, Schalij MJ. Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. J Am Coll Cardiol 2004;44:1834–1840.
Bax JJ, Marwick TH, Molhoek SG, Bleeker GB, van Erven L, Boersma E, Steendijk P, van der Wall EE, Schalij MJ. Left ventricular dyssynchrony predicts benefit of cardiac resynchronization therapy in patients with end-stage heart failure before pacemaker implantation. Am J Cardiol 2003;92:1238–1240.
Bruch C, Schmermund A, Marin D, Katz M, Bartl T, Scharr J, Erbel R, Tei-index in patients with mild-to-moderate congestive heart failure Eur Heart J 2000;21, 1888-1895
Cazeau S, Christophe L, Lavergne T, Walker S, Varma C, Linde C, Garrigue S, Kappenberger L, Santini M, Daubert J-C, for the Multisite Stimulation in Cardiomyopathies (MUSTIC) Study Investigators: Effects of Multisite Biventricular Pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med, 2001; 344: 873-80
Chung ES, Leon AR, Tavazzi L, Sun JP, Nihoyannopoulos P, Merlino J, Abraham WT, Ghio S, Leclercq C, Bax JJ, Yu CM, Gorcsan J III, John Sutton M, De Sutter J, Murillo J. Results of the predictors of response to CRT (PROSPECT) trial. Circulation 2008;117:2608–2616.
Dandel M, Kemper D, Lehmkuhl H, Hetzer R. Evaluation of left ventricular filling pressures by the Tei index. J Am Soc Echocardiogr 2004;17(6):709
Dickstein K, Vardas PE, Auricchio A, Daubert JC, Linde C, McMurray J, Ponikowski P, Priori SG, Sutton R, van Veldhuisen DJ; ESC Committee for Practice Guidelines, Vahanian A, Auricchio A, Bax J, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas P, Widimsky P, Tendera M, Anker SD, Blanc JJ, Gasparini M, Hoes AW, Israel CW, Kalarus Z, Merkely B, Swedberg K, Camm AJ. 2010 Focused Update of ESC Guidelines on device therapy in heart failure: an update of the 2008 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure and the 2007 ESC Guidelines for cardiac and resynchronization therapy. Developed with the special contribution of the Heart Failure Association and the European Heart Rhythm Association. Europace. 2010;12(11):1526-36.
Dujardin KS, Tei C, Yeo TC, Hodge DO, Rossi A, Seward JB. Prognostic value of a Doppler index combining systolic and diastolic performance in idiopathic-dilated cardiomyopathy. Am J Cardiol. 1998;82(9):1071-6
Hochleiter M, Hortanagle H, Ng CK, Gschnitzer F, Yechmann W. Usefulness of physiologic dual-chamber pacing in drug resistant idiopathic dilated cardiomzopathy. Am J Cardiol 1990; 66:198-202
Kass DA. Predicting cardiac resynchronization response by QRS duration: the long and short of it. J Am Coll Cardiol 2003; 42:2125-7
Lafitte S, Bordachar P, Lafitte M, Garrigue S, Reuter S, Reant P, Serri K, Lebouffos V, Berrhouet M, Jais P. Dynamic ventricular dyssynchrony: an exercise-echocardiography study. J Am Coll Cardiol 2006;47:2253–2259.
Lakoumentas JA, Panou FK, Kotseroglou VK, Aggeli KI, Harbis PK. The Tei index of myocardial performance: applications in cardiology. Hellenic J Cardiol. 2005;46(1):52-8.
Marwick TH. Hype and hope in the use of echocardiography for selection for cardiac resynchronization therapy: the Tower of Babel revisited. Circulation 2008;117:2573–2576.
Mollema SA, Liem SS, Suffoletto MS, Bleeker GB, van der Hoeven BL, van de Veire NR, Boersma E, Holman ER, van der Wall EE, Schalij MJ, Gorcsan J III, Bax JJ. Left ventricular dyssynchrony acutely after myocardial infarction predicts left ventricular remodeling. J Am Coll Cardiol 2007;50:1532–1540.
Nishimura RA, Hayes DL, Holmes DR et al. Mechanism of hemodynamic improvement by dual chamber pacing for severe left ventricular dysfunction. An acute Doppler echocardiografic and catheterization hemodynamic study. J Am Coll Cardiol 1996;27: 421-30
Notabartolo D, Merlino JD, Smith AL, DeLurgio DB, Vera FV, Easley KA, Martin RP, Leon AR. Usefulness of the peak velocity difference by tissue Doppler imaging technique as an effective predictor of response to cardiac resynchronization therapy. Am J Cardiol 2004;94:817–820.
Poerner TC, Goebel B, Geiger T, Haghi D, Borggrefe M, Haase KK. Physiological range of mechanical synchronicity of the human heart: comparison between different echocardiographic assessment modalities. Ultrasound Med Biol 2005;31: 1163–1172.
Su HM, Lin TH, Voon WC, Lee KT, Chu CS, Lai WT, Sheu SH. Differentiation of left ventricular diastolic dysfunction, identification of pseudonormal/restrictive mitral inflow pattern and determination of left ventricular filling pressure by Tei index obtained from tissue Doppler echocardiography. Echocardiography 2006;23(4):287-94
Suffoletto MS, Dohi K, Cannesson M, Saba S, Gorcsan J III. Novel speckle-tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy. Circulation 2006;113:960–968.
Tei C. New non-invasive index for combined systolic and diastolic ventricular function. J Cardiol 1995; 26:396-404
Tei C, Ling LH, Hodge DO et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function: a study in normals and dilated cardiomyopathiy. J Cardiol 1995;26:357-66
Toshinori Yuasa, Chinami Miyazaki, Jae K Oh, Raul E Espinosa, Charles J Bruce. Effects of cardiac resynchronization therapy on the Doppler Tei index. J Am Soc Echocardiogr 2009;22(3):253-260
Xiao HB, Roy C, Gibson DG. Nature of ventricular activation in patients with dilated cardiomyopathie. Br Heart J 1994 ;72 : 167-74
Yu CM, Chau E, Sanderson JE, Fan K, Tang MO, Fung WH, Lin H, Kong SL, Lam YM, Hill MRS, Lau CP. Tissue Doppler echocardiographic evidence of reverse remodeling and improved synchronicity by simultaneously delaying regional contraction after biventricular pacing therapy in heart failure. Circulation 2002;105:438–445.
Yu CM, Lin H, Zhang Q, Sanderson JE. High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration. Heart 2003;89:54–60.
Yu CM, Fung JW-H, Chan CK, Chan YS, Zhang Q, Lin H, Yip GWK, Kum LCC, Kong SL, Zhang Y, Sanderson JE. Comparison of efficacy of reverse remodeling and clinical improvement for relatively narrow and wide QRS complexes after cardiac resynchronization therapy for heart failure. J Cardiovasc Electrophysiol 2004;15:1058–1065.
Read_full_article: pdf/21-2011/21-1-2011/SU21-1-2011Nicolin.pdf
Correspondence: Nicolin Roxana Mihaela “Victor Babes” Timisoara University Of Medicine And Pharmacy Timisoara, Str PP Carp, Nr 13A Romania Tel: 0040256207355 Fax: 0040256207362 E-Mail: nicolinmihaela@yahoo.com

Read full article
Article Title: The value of global myocardial index to detect cardiac dyssynchrony in patients with non-ischemic dilated cardiomyopathy
Authors: Mihaela Nicolin, Cristian Mornos, Adina Ionac, Aniko Mornos, Sorin Pescariu, Stefan-Iosif Dragulescu
Affiliation: 1 “Victor Babes” Timisoara University of Medicine and Pharmacy, Timisoara, Romania
2MD, PhD, “Victor Babes” Timisoara University of Medicine and Pharmacy, Timisoara, Romania
3MD, PhD, “Victor Babes” Timisoara University of Medicine and Pharmacy, Timisoara, Romania
4MD, “Victor Babes” Timisoara University of Medicine and Pharmacy, Timisoara, Romania
5MD, PhD, “Victor Babes” Timisoara University of Medicine and Pharmacy, Timisoara, Romania
6MD, Prof, PhD, FESC, “Victor Babes” Timisoara University of Medicine and Pharmacy, Timisoara, Romania
Abstract: A variety of parameters has been proposed in left ventricular (LV) asynchrony evaluation. Echocardiography was performed in 95 patients with non-ischemic dilated cardiomyopathy (DCM). Global myocardial index (GMI) and time to peak systolic velocity (Ts) was measured from the beginning of the QRS complex to the peak myocardial systolic velocity. Absolute difference in Ts between any two of the four basal LV segments, absolute difference in Ts between any two of the six basal LV segments, absolute difference in Ts between any 2 of the 12 (6 basal and 6 mid) LV segments, and standard deviation of Ts of the 12 (6 basal and 6 mid) LV segments were derived. A composite score was calculated combining the above four dyssynchrony parameters. All GMI differed significantly among dyssynchrony groups. The area under ROC-curve to detect patients with all four criteria of dyssynchrony was 0.94 for GMI (100% sensitivity, 90% specificity). In conclusion, GMI could be used as simple index to detect LV desynchronization in DCM.
Keywords: Cardiac dyssynchrony, Global myocardial index, Tissue Doppler Imaging
References: Abraham WT, Fisher WG, Smith AL, et al. for the MIRACLE study group. Cardiac resynchronization in chronic heart failure N Engl J Med, 2002; 346: 1845-53
Bax JJ, Bleeker GB, Marwick TH, Molhoek SG, Boersma E, Steendijk P, van der Wall EE, Schalij MJ. Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. J Am Coll Cardiol 2004;44:1834–1840.
Bax JJ, Marwick TH, Molhoek SG, Bleeker GB, van Erven L, Boersma E, Steendijk P, van der Wall EE, Schalij MJ. Left ventricular dyssynchrony predicts benefit of cardiac resynchronization therapy in patients with end-stage heart failure before pacemaker implantation. Am J Cardiol 2003;92:1238–1240.
Bruch C, Schmermund A, Marin D, Katz M, Bartl T, Scharr J, Erbel R, Tei-index in patients with mild-to-moderate congestive heart failure Eur Heart J 2000;21, 1888-1895
Cazeau S, Christophe L, Lavergne T, Walker S, Varma C, Linde C, Garrigue S, Kappenberger L, Santini M, Daubert J-C, for the Multisite Stimulation in Cardiomyopathies (MUSTIC) Study Investigators: Effects of Multisite Biventricular Pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med, 2001; 344: 873-80
Chung ES, Leon AR, Tavazzi L, Sun JP, Nihoyannopoulos P, Merlino J, Abraham WT, Ghio S, Leclercq C, Bax JJ, Yu CM, Gorcsan J III, John Sutton M, De Sutter J, Murillo J. Results of the predictors of response to CRT (PROSPECT) trial. Circulation 2008;117:2608–2616.
Dandel M, Kemper D, Lehmkuhl H, Hetzer R. Evaluation of left ventricular filling pressures by the Tei index. J Am Soc Echocardiogr 2004;17(6):709
Dickstein K, Vardas PE, Auricchio A, Daubert JC, Linde C, McMurray J, Ponikowski P, Priori SG, Sutton R, van Veldhuisen DJ; ESC Committee for Practice Guidelines, Vahanian A, Auricchio A, Bax J, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas P, Widimsky P, Tendera M, Anker SD, Blanc JJ, Gasparini M, Hoes AW, Israel CW, Kalarus Z, Merkely B, Swedberg K, Camm AJ. 2010 Focused Update of ESC Guidelines on device therapy in heart failure: an update of the 2008 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure and the 2007 ESC Guidelines for cardiac and resynchronization therapy. Developed with the special contribution of the Heart Failure Association and the European Heart Rhythm Association. Europace. 2010;12(11):1526-36.
Dujardin KS, Tei C, Yeo TC, Hodge DO, Rossi A, Seward JB. Prognostic value of a Doppler index combining systolic and diastolic performance in idiopathic-dilated cardiomyopathy. Am J Cardiol. 1998;82(9):1071-6
Hochleiter M, Hortanagle H, Ng CK, Gschnitzer F, Yechmann W. Usefulness of physiologic dual-chamber pacing in drug resistant idiopathic dilated cardiomzopathy. Am J Cardiol 1990; 66:198-202
Kass DA. Predicting cardiac resynchronization response by QRS duration: the long and short of it. J Am Coll Cardiol 2003; 42:2125-7
Lafitte S, Bordachar P, Lafitte M, Garrigue S, Reuter S, Reant P, Serri K, Lebouffos V, Berrhouet M, Jais P. Dynamic ventricular dyssynchrony: an exercise-echocardiography study. J Am Coll Cardiol 2006;47:2253–2259.
Lakoumentas JA, Panou FK, Kotseroglou VK, Aggeli KI, Harbis PK. The Tei index of myocardial performance: applications in cardiology. Hellenic J Cardiol. 2005;46(1):52-8.
Marwick TH. Hype and hope in the use of echocardiography for selection for cardiac resynchronization therapy: the Tower of Babel revisited. Circulation 2008;117:2573–2576.
Mollema SA, Liem SS, Suffoletto MS, Bleeker GB, van der Hoeven BL, van de Veire NR, Boersma E, Holman ER, van der Wall EE, Schalij MJ, Gorcsan J III, Bax JJ. Left ventricular dyssynchrony acutely after myocardial infarction predicts left ventricular remodeling. J Am Coll Cardiol 2007;50:1532–1540.
Nishimura RA, Hayes DL, Holmes DR et al. Mechanism of hemodynamic improvement by dual chamber pacing for severe left ventricular dysfunction. An acute Doppler echocardiografic and catheterization hemodynamic study. J Am Coll Cardiol 1996;27: 421-30
Notabartolo D, Merlino JD, Smith AL, DeLurgio DB, Vera FV, Easley KA, Martin RP, Leon AR. Usefulness of the peak velocity difference by tissue Doppler imaging technique as an effective predictor of response to cardiac resynchronization therapy. Am J Cardiol 2004;94:817–820.
Poerner TC, Goebel B, Geiger T, Haghi D, Borggrefe M, Haase KK. Physiological range of mechanical synchronicity of the human heart: comparison between different echocardiographic assessment modalities. Ultrasound Med Biol 2005;31: 1163–1172.
Su HM, Lin TH, Voon WC, Lee KT, Chu CS, Lai WT, Sheu SH. Differentiation of left ventricular diastolic dysfunction, identification of pseudonormal/restrictive mitral inflow pattern and determination of left ventricular filling pressure by Tei index obtained from tissue Doppler echocardiography. Echocardiography 2006;23(4):287-94
Suffoletto MS, Dohi K, Cannesson M, Saba S, Gorcsan J III. Novel speckle-tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy. Circulation 2006;113:960–968.
Tei C. New non-invasive index for combined systolic and diastolic ventricular function. J Cardiol 1995; 26:396-404
Tei C, Ling LH, Hodge DO et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function: a study in normals and dilated cardiomyopathiy. J Cardiol 1995;26:357-66
Toshinori Yuasa, Chinami Miyazaki, Jae K Oh, Raul E Espinosa, Charles J Bruce. Effects of cardiac resynchronization therapy on the Doppler Tei index. J Am Soc Echocardiogr 2009;22(3):253-260
Xiao HB, Roy C, Gibson DG. Nature of ventricular activation in patients with dilated cardiomyopathie. Br Heart J 1994 ;72 : 167-74
Yu CM, Chau E, Sanderson JE, Fan K, Tang MO, Fung WH, Lin H, Kong SL, Lam YM, Hill MRS, Lau CP. Tissue Doppler echocardiographic evidence of reverse remodeling and improved synchronicity by simultaneously delaying regional contraction after biventricular pacing therapy in heart failure. Circulation 2002;105:438–445.
Yu CM, Lin H, Zhang Q, Sanderson JE. High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration. Heart 2003;89:54–60.
Yu CM, Fung JW-H, Chan CK, Chan YS, Zhang Q, Lin H, Yip GWK, Kum LCC, Kong SL, Zhang Y, Sanderson JE. Comparison of efficacy of reverse remodeling and clinical improvement for relatively narrow and wide QRS complexes after cardiac resynchronization therapy for heart failure. J Cardiovasc Electrophysiol 2004;15:1058–1065.
*Correspondence: Nicolin Roxana Mihaela “Victor Babes” Timisoara University Of Medicine And Pharmacy Timisoara, Str PP Carp, Nr 13A Romania Tel: 0040256207355 Fax: 0040256207362 E-Mail: nicolinmihaela@yahoo.com