- 1. 5652Taiwan Heart Rhythm Society Oct. 2012 t VOL.
007(101.02.17)Shih-A ChenShih-Ann Chen -Ann(Taiwan Heart Rhythm
Society) t )1004150222610041502226886-2-23821530 :886-2-23821528 1)
www.thrs.org.tw I S S N 2 2 2 3 - 0 1 3 0 2) Yenn-JiangYenn-Jiang
LinJin-LongJin-Long Huang 3) Po-ChingPo-Ching Chi 4) 101
Wei-HuaWei-Hua TangJan-YowJan-Yow Chen 102 Shih-ChungShih-Chung
Huang Bien-Hsien HuangBien-HsienWen-ChinWen-Chin Tsai
Shih-TsungShih-Tsung ChengTze-Tze- Fan Chao Hung-YuHung-Yu
ChangShuenn-NanShuenn-Nan Chiu 1 - P1 2 - P1(cardiac dyssynchrony)3
- P5 QRSQRS complex4 EKG of the month - P6 Purkinje5 - P6 6 - P7
QRS7 Paradigm Shift in StrokeQRS complex120Prevention for AF - P10
20%8 - P1135%
2. 2 THRS Taiwan Heart Rhythm Society10110VOL. 007 SRI (low
signal-to-noise ratio) high intra- and interob- server
variability(ventricular interdepedence) M-modeCRT response(tissue
Doppler MUSTIC-SRPATH-imageTDI) (strain rate image
CHFMIRACLEMIRACLE-ICDCOMPANIONSRI)(tissue synchronization
imagingCARE-HRQRS duration160TSI) 30%CRT(Table 1) QRS durationCRT
response(Interventricular mechanical delayIVMD)MollemaAJC
2007DelgadoCirculation 2012QRSbaseline QRS durationCRT responseQRS
durationIVMD401.,(left ventricular pre-ejection
in-endocardialepicardial mappingtervals (LPEI)QRS1402.Left lateral
wall contraction (LLWC)M-modeDopplerCRT responseE wave3.
Septal-to-posterior wall motion delay (SPWMD)M-mode CRT response130
TDITDIbasalmid-seg- CRT response(Table 2)mentstime to peak
systolicCARE-HFIVMD40velocity (Ts) time to onset of systolic
velocity (electro- CRTresponse (hazard ration 0.99 95% condience
in- 1mechanical delayEMD)dyssyn-terval 0.98 to 1.00) M-modeSPWMD130
2,3chrony indexCRT response )6512akinesis 4(Ts-SD-12)Ts-SD-1232
TDIdyssynchrony index65CRTreverse remodeling5TSITSI92% 6speckle
track-TsCRT response 12ing Ts-SD-1231.47 CRT response TDISRITDI
(rotation) (radial strain)CRT 8(tethering)SRI response
9(deformation)TDICRT response Table 1: Summary of the Main Clinical
Trials of CRT Numbers QRSResponseNYHA functional class LVEF (%)
Trials (source)ofdurationRate(%) patients (ms) (%) IIIIV MUSTIC-SR
(N Engl J Med. 2001)5817619- 237 100- PATH-CHF (J Am Coll Cardiol.
2002)4117430- 216 5149 MIRACLE (N Engl J Med. 2002) 45316721 64 226
9010 MIRACLE-ICD (JAMA. 2003) 36916222 61 246 8812 COMPANION (N
Engl J Med. 2004)1520 160 59218713 CARE-HR (N Engl J Med. 2005) 813
160-257723 3. VOL. 007Taiwan Heart Rhythm Society10110THRS 3Table
2: Studies Evaluating the Role of Cardiac Dyssynchrony to Predict
Long-Term Outcome After CRT CardiacPatients Follow-upFirst Author
(source) dyssynchronyEnd point HR (95%
CI)(n)(months)parameterCleland (N Engl J Med. 2005)813 29.4 IVMD
>49.2 ms All-cause mortality0.50 (0.360.70) or hospitalization
for heart failureWiesbauer (Eur J Clin Invest. 2009) 200 10 IVMD
>60 ms All-cause mortality0.21 (0.070.6)Cho (J Am Coll Cardiol.
2005) 1061711 TDI maximal opposingAll-cause mortality9.02
(2.4233.57) delay (8 LV segments) >91 msZhang (Heart. 2009)
2393720 TDI maximal opposing Cardiovascular 0.46 (0.2700.792) delay
65 ms mortalityCho (Heart. 2010) 167 33 TDI maximal opposing
Cardiovascular 2.37 (1.394.04) delay 65 ms mortality
andhospitalization forheart failureLeyva (Heart. 2009) 148 30 SD of
time to peak Cardiovascular 1.01 (1.001.02) radial
motion-MRImortalityHR indicates hazard ratio; CI, condence
interval; IVMD, interventricular mechanical delay; and TDI, tissue
Doppler imaging.PROSPECT trialdyssynchronyCRT re- pulse-wave
Doppler5sponse tissue DopplerCRT intraobserverinterobserver
variabilityPROSPECT (Predictors of Response to Cardiac Re-
10Synchronization Therapy) 324
dys-PROSPECTdyssynchronyCRTsynchronyCRTdyssynchrony(Table 3)
(speckle (KCCQ Kansas City Cardiomyopathy tracking) PROSPECT
studyQuestionnaire)CRT ( (Table 4)CRT15%) IVMD, LVFT (LV filling
dyssynchronytime), LVPEI CRTIVMD (+5.18, p=0.02) LVFT (+5.19,
p=0.03) (externalIVMD (OR 1.85,
p=0.03)validation)dyssynchronyCRTPROSPECTCRT responder, 76%. CRT
PROSPECTdys-LVFT () synchronyLVFTTable 3: Dyssynchrony
Echocardiographic MethodEchocardiographic Dyssynchrony Measures
M-modeSeptal-posterior wall motion delay (130 ms). Pulsed Dopper 1.
Interventricular mechanical delay (40 ms). 2. LV lling time
relative to RR (40%).3.LV pre-ejection interval (>140 ms).
M-model + Pulsed Dopper Left lateral wall contraction overlap with
LV lling (0). Tissue Doppler imaging1. Time difference between
laterl and septal peak systolic wall velocity (60 ms). 2. SD of
time to peak velocity (32 ms). 3. Maximum difference of time to
peak velocity (median). 4. Maximum difference of time to onset
systolic velocity (median). 5. Delayed longitudinal contraction
(2). 6. Maximum difference of time to peak velocity outside IVCT
(110 ms). 7. Maximum difference of time to peak displacement
(median). 4. 4 THRSTaiwan Heart Rhythm Society10110 VOL. 007Table
4: PROSPECTPROSPECT 20.2%LVEF >35%LVEF35%,37.8%LVEDD
