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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