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Table 1 Concise summary of the different approaches to echocardiographic measurement of asynchrony

From: Tissue Doppler echocardiography and biventricular pacing in heart failure: Patient selection, procedural guidance, follow-up, quantification of success

Assessment of asynchrony with:

Ref.

Criteria

Segments

Limitations

Analysis time

Prediction of benefit

I. Global ventricular asynchrony

ECG

4, 44

QRS width >120 ms

Global assessment

LBBB after myocardial infarction

Short

Low (30% non-responder)

M-mode

21

Septal-to-posterior wall motion delay >130 ms

septal and posterior

scar tissue, only septal or posterior

Short

low

pw-TDI

25

Cumulative asynchrony (EMD) >102 ms

Intra LV (5 basal segments) and interventricular (vs. RV lateral segment)

Low spatial resolution

Long

Good prediction of acute response (AUC in ROC 0,84)

II. Interventricular asynchrony

pw-Doppler echocardiography

47

Interventricular mechanical delay (IVMD) >40 ms

Aortic and pulmonary outflow tract

Not simultaneous

Short

No

III. Intraventricular asynchrony

2D-TDI

27

Ts-SD: intraventricular systolic asynchrony index: >33 ms

12 segments

complex (post-processing)

Long

Acute response (3 months)

 

4, 32

Difference in septal-lateral time-to-peak TDI, cut-off >60 ms

12 segments

Complex

Long

EF increase after BVP

 

40

Mean regional myocardial performance index: Difference between regional Q-wave-to.peak systolic displacement times

12 segments

4 segments

Complex

Long, offline

Acute response

 

33

Ts-SD: cut-off: 31,4 ms

12 segments

Complex

Long

3 months response, reverse remodeling

Strain and strain rate

15, 34, 33

Myocardial deformation in systole, presence of post-systolic shortening

12 segments

Complex, time consuming, in dilated ventricles low spatial resolution)

Long

Controversial data

Tissue Tracking

28

DLC in >2 basal segments

12 basal segments in apical four chamber view.

Requires correct timing of LV events

Short

Acute response

TSI

36

Color-coded time-to-peak tissue Doppler velocities (cut-off >65 ms in anteroseptum and posterior wall in apical long axis view)

16 segments except apex

Only velocity data

Short

Acute response (Sensitivity 87% Specificity 100%)

3-D-echo

26

No quantitative criteria defined

All segments

Reduced spatial resolution

Time consuming, off-line analysis

No systematic data

Automated endocardial border detection (ABD)

26

Septal-lateral phase angle difference

100 segments. apical-four-chamber view (septal-lateral)

High complexity, single imaging plane

Long, only off-line

Acute response

ABD + Contrast

46

Echo-contrast cardiac variability imaging: displacement maps

apical four chamber

High complexity, single imaging plane

Long

Acute response