Effect of low-amplitude two-dimensional radial strain at left ventricular pacing sites on response to cardiac resynchronization therapy

Fakhar Zaman Khan, Munmohan Singh Virdee, Philip A. Read, Peter J. Pugh, Denis O'Halloran, Michael Fahey, Maros Elsik, David Begley, Simon Patrick Fynn, David Paul Dutka

Research output: Contribution to journalComment / DebateOtherpeer-review

33 Citations (Scopus)


Background: Left ventricular (LV) lead placement to areas of scar has detrimental effects on response to cardiac resynchronization therapy (CRT). Speckle-tracking radial two-dimensional strain offers assessment of the extent of regional myocardial deformation. The aim of this study was to assess the impact of LV lead placement at areas of low-amplitude strain on CRT response. Methods: The optimal cutoff of radial strain amplitude at the LV pacing site associated with an unfavorable CRT response was determined in a derivation group (n = 65) and then tested in a second consecutive validation group (n = 75) of patients with heart failure. Patients had concordant LV leads if placed at the most delayed site, and dyssynchrony was defined as anteroseptal to posterior delay ≥ 130 msec. CRT response was defined as a ≥15% reduction in LV end-systolic volume at 6 months. Results: In the derivation group, a derived cutoff for radial strain amplitude of <9.8% defined low-amplitude segments (LAS) and had a high specificity but low sensitivity for predicting LV reverse remodeling, suggesting a strong negative predictive value. In the validation group, compared with patients without LAS at the LV pacing site, in patients with LAS (n = 16), CRT response was significantly lower (62.7% vs 31.3%, P < .05). By multivariate analysis, LV lead concordance and the absence of an LAS at the LV pacing site but not dyssynchrony were significantly related to CRT response. Conclusion: LV lead placement over segments with two-dimensional radial strain amplitudes <9.8% is associated with poor outcomes of CRT.

Original languageEnglish
Pages (from-to)1168-1176
Number of pages9
JournalJournal of the American Society of Echocardiography
Issue number11
Publication statusPublished - Nov 2010
Externally publishedYes


  • Cardiac resynchronization therapy
  • Dyssynchrony
  • LV pacing site
  • Scar
  • Two-dimensional radial strain

Cite this