Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy: results of the Speckle Tracking and Resynchronization (STAR) study
Identifieur interne : 000991 ( Istex/Corpus ); précédent : 000990; suivant : 000992Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy: results of the Speckle Tracking and Resynchronization (STAR) study
Auteurs : Hidekazu Tanaka ; Hans-Joachim Nesser ; Thomas Buck ; Olusegun Oyenuga ; Rolf Alexander Jnosi ; Siegmund Winter ; Samir Saba ; John GorcsanSource :
- European Heart Journal [ 0195-668X ] ; 2010-07.
Abstract
Aims The Speckle Tracking and Resynchronization (STAR) study used a prospective multi-centre design to test the hypothesis that speckle-tracking echocardiography can predict response to cardiac resynchronization therapy (CRT). Methods and results We studied 132 consecutive CRT patients with class III and IV heart failure, ejection fraction (EF) 35, and QRS 120 ms from three international centres. Baseline dyssynchrony was evaluated by four speckle tracking strain methods; radial, circumferential, transverse, and longitudinal (130 ms opposing wall delay for each). Pre-specified outcome variables were EF response and three serious long-term events: death, transplant, or left ventricular assist device. Of 120 patients (91) with baseline dyssynchrony data, both short-axis radial strain and transverse strain from apical views were associated with favourable EF response 7 4 months and long-term outcome over 3.5 years (P < 0.01). Radial strain had the highest sensitivity at 86 for predicting EF response with a specificity of 67. Serious long-term unfavourable events occurred in 20 patients after CRT, and happened three times more frequently in those who lacked baseline radial or transverse dyssynchrony than in patients with dyssynchrony (P < 0.01). Patients who lacked both radial and transverse dyssynchrony had unfavourable clinical events occur in 53, in contrast to events occurring in 12 if baseline dyssynchrony was present (P < 0.01). Circumferential and longitudinal strains predicted response when dyssynchrony was detected, but failed to identify dyssynchrony in one-third of patients who responded to CRT. Conclusion Dyssynchrony by speckle-tracking echocardiography using radial and transverse strains is associated with EF response and long-term outcome following CRT.
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DOI: 10.1093/eurheartj/ehq213
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Buck</name><affiliation><mods:affiliation>University Hospital Essen, Essen, Germany</mods:affiliation></affiliation></author><author><name sortKey="Oyenuga, Olusegun" sort="Oyenuga, Olusegun" uniqKey="Oyenuga O" first="Olusegun" last="Oyenuga">Olusegun Oyenuga</name><affiliation><mods:affiliation>University of Pittsburgh, Scaife Hall 564, 200 Lothrop Street, Pittsburgh, PA15213-2582, USA</mods:affiliation></affiliation></author><author><name sortKey="Jnosi, Rolf Alexander" sort="Jnosi, Rolf Alexander" uniqKey="Jnosi R" first="Rolf Alexander" last="Jnosi">Rolf Alexander Jnosi</name><affiliation><mods:affiliation>University Hospital Essen, Essen, Germany</mods:affiliation></affiliation></author><author><name sortKey="Winter, Siegmund" sort="Winter, Siegmund" uniqKey="Winter S" first="Siegmund" last="Winter">Siegmund Winter</name><affiliation><mods:affiliation>Elisabethinen University Teaching Hospital, Linz, Austria</mods:affiliation></affiliation></author><author><name sortKey="Saba, Samir" sort="Saba, Samir" uniqKey="Saba S" first="Samir" last="Saba">Samir Saba</name><affiliation><mods:affiliation>University of Pittsburgh, Scaife Hall 564, 200 Lothrop Street, Pittsburgh, PA15213-2582, USA</mods:affiliation></affiliation></author><author><name sortKey="Gorcsan, John" sort="Gorcsan, John" uniqKey="Gorcsan J" first="John" last="Gorcsan">John Gorcsan</name><affiliation><mods:affiliation>University of Pittsburgh, Scaife Hall 564, 200 Lothrop Street, Pittsburgh, PA15213-2582, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: gorcsanj@upmc.edu</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:5E58002435C3C9B165EA7ED33FA1E0E13B45E212</idno><date when="2010" year="2010">2010</date><idno type="doi">10.1093/eurheartj/ehq213</idno><idno type="url">https://api.istex.fr/document/5E58002435C3C9B165EA7ED33FA1E0E13B45E212/fulltext/pdf</idno><idno 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Buck</name><affiliation><mods:affiliation>University Hospital Essen, Essen, Germany</mods:affiliation></affiliation></author><author><name sortKey="Oyenuga, Olusegun" sort="Oyenuga, Olusegun" uniqKey="Oyenuga O" first="Olusegun" last="Oyenuga">Olusegun Oyenuga</name><affiliation><mods:affiliation>University of Pittsburgh, Scaife Hall 564, 200 Lothrop Street, Pittsburgh, PA15213-2582, USA</mods:affiliation></affiliation></author><author><name sortKey="Jnosi, Rolf Alexander" sort="Jnosi, Rolf Alexander" uniqKey="Jnosi R" first="Rolf Alexander" last="Jnosi">Rolf Alexander Jnosi</name><affiliation><mods:affiliation>University Hospital Essen, Essen, Germany</mods:affiliation></affiliation></author><author><name sortKey="Winter, Siegmund" sort="Winter, Siegmund" uniqKey="Winter S" first="Siegmund" last="Winter">Siegmund Winter</name><affiliation><mods:affiliation>Elisabethinen University Teaching Hospital, Linz, Austria</mods:affiliation></affiliation></author><author><name sortKey="Saba, Samir" sort="Saba, Samir" uniqKey="Saba S" first="Samir" last="Saba">Samir Saba</name><affiliation><mods:affiliation>University of Pittsburgh, Scaife Hall 564, 200 Lothrop Street, Pittsburgh, PA15213-2582, USA</mods:affiliation></affiliation></author><author><name sortKey="Gorcsan, John" sort="Gorcsan, John" uniqKey="Gorcsan J" first="John" last="Gorcsan">John Gorcsan</name><affiliation><mods:affiliation>University of Pittsburgh, Scaife Hall 564, 200 Lothrop Street, Pittsburgh, PA15213-2582, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: gorcsanj@upmc.edu</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">European Heart Journal</title><idno type="ISSN">0195-668X</idno><idno type="eISSN">1522-9645</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2010-07">2010-07</date><biblScope unit="volume">31</biblScope><biblScope unit="issue">14</biblScope><biblScope unit="page" from="1690">1690</biblScope><biblScope unit="page" to="1700">1700</biblScope></imprint><idno type="ISSN">0195-668X</idno></series><idno type="istex">5E58002435C3C9B165EA7ED33FA1E0E13B45E212</idno><idno type="DOI">10.1093/eurheartj/ehq213</idno><idno type="ArticleID">ehq213</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0195-668X</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Aims The Speckle Tracking and Resynchronization (STAR) study used a prospective multi-centre design to test the hypothesis that speckle-tracking echocardiography can predict response to cardiac resynchronization therapy (CRT). Methods and results We studied 132 consecutive CRT patients with class III and IV heart failure, ejection fraction (EF) 35, and QRS 120 ms from three international centres. Baseline dyssynchrony was evaluated by four speckle tracking strain methods; radial, circumferential, transverse, and longitudinal (130 ms opposing wall delay for each). Pre-specified outcome variables were EF response and three serious long-term events: death, transplant, or left ventricular assist device. Of 120 patients (91) with baseline dyssynchrony data, both short-axis radial strain and transverse strain from apical views were associated with favourable EF response 7 4 months and long-term outcome over 3.5 years (P < 0.01). Radial strain had the highest sensitivity at 86 for predicting EF response with a specificity of 67. Serious long-term unfavourable events occurred in 20 patients after CRT, and happened three times more frequently in those who lacked baseline radial or transverse dyssynchrony than in patients with dyssynchrony (P < 0.01). Patients who lacked both radial and transverse dyssynchrony had unfavourable clinical events occur in 53, in contrast to events occurring in 12 if baseline dyssynchrony was present (P < 0.01). Circumferential and longitudinal strains predicted response when dyssynchrony was detected, but failed to identify dyssynchrony in one-third of patients who responded to CRT. Conclusion Dyssynchrony by speckle-tracking echocardiography using radial and transverse strains is associated with EF response and long-term outcome following CRT.</div></front></TEI><istex><corpusName>oup</corpusName><author><json:item><name>Hidekazu Tanaka</name><affiliations><json:string>University of Pittsburgh, Scaife Hall 564, 200 Lothrop Street, Pittsburgh, PA15213-2582, USA</json:string></affiliations></json:item><json:item><name>Hans-Joachim Nesser</name><affiliations><json:string>Elisabethinen University Teaching Hospital, Linz, Austria</json:string></affiliations></json:item><json:item><name>Thomas Buck</name><affiliations><json:string>University Hospital Essen, Essen, Germany</json:string></affiliations></json:item><json:item><name>Olusegun Oyenuga</name><affiliations><json:string>University of Pittsburgh, Scaife Hall 564, 200 Lothrop Street, Pittsburgh, PA15213-2582, USA</json:string></affiliations></json:item><json:item><name>Rolf Alexander Jnosi</name><affiliations><json:string>University Hospital Essen, Essen, Germany</json:string></affiliations></json:item><json:item><name>Siegmund Winter</name><affiliations><json:string>Elisabethinen University Teaching Hospital, Linz, Austria</json:string></affiliations></json:item><json:item><name>Samir Saba</name><affiliations><json:string>University of Pittsburgh, Scaife Hall 564, 200 Lothrop Street, Pittsburgh, PA15213-2582, USA</json:string></affiliations></json:item><json:item><name>John Gorcsan III</name><affiliations><json:string>University of Pittsburgh, Scaife Hall 564, 200 Lothrop Street, Pittsburgh, PA15213-2582, USA</json:string><json:string>E-mail: gorcsanj@upmc.edu</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Echocardiography</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Heart failure</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Pacing therapy</value></json:item></subject><articleId><json:string>ehq213</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>Aims The Speckle Tracking and Resynchronization (STAR) study used a prospective multi-centre design to test the hypothesis that speckle-tracking echocardiography can predict response to cardiac resynchronization therapy (CRT). Methods and results We studied 132 consecutive CRT patients with class III and IV heart failure, ejection fraction (EF) 35, and QRS 120 ms from three international centres. Baseline dyssynchrony was evaluated by four speckle tracking strain methods; radial, circumferential, transverse, and longitudinal (130 ms opposing wall delay for each). Pre-specified outcome variables were EF response and three serious long-term events: death, transplant, or left ventricular assist device. Of 120 patients (91) with baseline dyssynchrony data, both short-axis radial strain and transverse strain from apical views were associated with favourable EF response 7 4 months and long-term outcome over 3.5 years (P > 0.01). Radial strain had the highest sensitivity at 86 for predicting EF response with a specificity of 67. Serious long-term unfavourable events occurred in 20 patients after CRT, and happened three times more frequently in those who lacked baseline radial or transverse dyssynchrony than in patients with dyssynchrony (P > 0.01). Patients who lacked both radial and transverse dyssynchrony had unfavourable clinical events occur in 53, in contrast to events occurring in 12 if baseline dyssynchrony was present (P > 0.01). Circumferential and longitudinal strains predicted response when dyssynchrony was detected, but failed to identify dyssynchrony in one-third of patients who responded to CRT. Conclusion Dyssynchrony by speckle-tracking echocardiography using radial and transverse strains is associated with EF response and long-term outcome following CRT.</abstract><qualityIndicators><score>9</score><pdfVersion>1.5</pdfVersion><pdfPageSize>595.276 x 793.701 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>3</keywordCount><abstractCharCount>1794</abstractCharCount><pdfWordCount>5623</pdfWordCount><pdfCharCount>38800</pdfCharCount><pdfPageCount>11</pdfPageCount><abstractWordCount>255</abstractWordCount></qualityIndicators><title>Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy: results of the Speckle Tracking and Resynchronization (STAR) study</title><genre><json:string>research-article</json:string></genre><host><volume>31</volume><publisherId><json:string>eurheartj</json:string></publisherId><pages><last>1700</last><first>1690</first></pages><issn><json:string>0195-668X</json:string></issn><issue>14</issue><genre><json:string>journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1522-9645</json:string></eissn><title>European Heart Journal</title></host><categories><wos><json:string>CARDIAC & CARDIOVASCULAR SYSTEMS</json:string></wos></categories><publicationDate>2010</publicationDate><copyrightDate>2010</copyrightDate><doi><json:string>10.1093/eurheartj/ehq213</json:string></doi><id>5E58002435C3C9B165EA7ED33FA1E0E13B45E212</id><score>0.26701373</score><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/5E58002435C3C9B165EA7ED33FA1E0E13B45E212/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/5E58002435C3C9B165EA7ED33FA1E0E13B45E212/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/5E58002435C3C9B165EA7ED33FA1E0E13B45E212/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy: results of the Speckle Tracking and Resynchronization (STAR) study</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Oxford University Press</publisher><availability><p>Published on behalf of the European Society of Cardiology. All rights reserved. The Author 2010. For permissions please email: journals.permissionsoxfordjournals.org</p></availability><date>2010-06-08</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy: results of the Speckle Tracking and Resynchronization (STAR) study</title><author xml:id="author-1"><persName><forename type="first">Hidekazu</forename><surname>Tanaka</surname></persName><affiliation>University of Pittsburgh, Scaife Hall 564, 200 Lothrop Street, Pittsburgh, PA15213-2582, USA</affiliation></author><author xml:id="author-2"><persName><forename type="first">Hans-Joachim</forename><surname>Nesser</surname></persName><affiliation>Elisabethinen University Teaching Hospital, Linz, Austria</affiliation></author><author xml:id="author-3"><persName><forename type="first">Thomas</forename><surname>Buck</surname></persName><affiliation>University Hospital Essen, Essen, Germany</affiliation></author><author xml:id="author-4"><persName><forename type="first">Olusegun</forename><surname>Oyenuga</surname></persName><affiliation>University of Pittsburgh, Scaife Hall 564, 200 Lothrop Street, Pittsburgh, PA15213-2582, USA</affiliation></author><author xml:id="author-5"><persName><forename type="first">Rolf Alexander</forename><surname>Jnosi</surname></persName><affiliation>University Hospital Essen, Essen, Germany</affiliation></author><author xml:id="author-6"><persName><forename type="first">Siegmund</forename><surname>Winter</surname></persName><affiliation>Elisabethinen University Teaching Hospital, Linz, Austria</affiliation></author><author xml:id="author-7"><persName><forename type="first">Samir</forename><surname>Saba</surname></persName><affiliation>University of Pittsburgh, Scaife Hall 564, 200 Lothrop Street, Pittsburgh, PA15213-2582, USA</affiliation></author><author xml:id="author-8"><persName><forename type="first">John</forename><surname>Gorcsan</surname></persName><roleName type="degree">III</roleName><email>gorcsanj@upmc.edu</email><affiliation>University of Pittsburgh, Scaife Hall 564, 200 Lothrop Street, Pittsburgh, PA15213-2582, USA</affiliation></author></analytic><monogr><title level="j">European Heart Journal</title><idno type="pISSN">0195-668X</idno><idno type="eISSN">1522-9645</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2010-07"></date><biblScope unit="volume">31</biblScope><biblScope unit="issue">14</biblScope><biblScope unit="page" from="1690">1690</biblScope><biblScope unit="page" to="1700">1700</biblScope></imprint></monogr><idno type="istex">5E58002435C3C9B165EA7ED33FA1E0E13B45E212</idno><idno type="DOI">10.1093/eurheartj/ehq213</idno><idno type="ArticleID">ehq213</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2010-06-08</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Aims The Speckle Tracking and Resynchronization (STAR) study used a prospective multi-centre design to test the hypothesis that speckle-tracking echocardiography can predict response to cardiac resynchronization therapy (CRT). Methods and results We studied 132 consecutive CRT patients with class III and IV heart failure, ejection fraction (EF) 35, and QRS 120 ms from three international centres. Baseline dyssynchrony was evaluated by four speckle tracking strain methods; radial, circumferential, transverse, and longitudinal (130 ms opposing wall delay for each). Pre-specified outcome variables were EF response and three serious long-term events: death, transplant, or left ventricular assist device. Of 120 patients (91) with baseline dyssynchrony data, both short-axis radial strain and transverse strain from apical views were associated with favourable EF response 7 4 months and long-term outcome over 3.5 years (P < 0.01). Radial strain had the highest sensitivity at 86 for predicting EF response with a specificity of 67. Serious long-term unfavourable events occurred in 20 patients after CRT, and happened three times more frequently in those who lacked baseline radial or transverse dyssynchrony than in patients with dyssynchrony (P < 0.01). Patients who lacked both radial and transverse dyssynchrony had unfavourable clinical events occur in 53, in contrast to events occurring in 12 if baseline dyssynchrony was present (P < 0.01). Circumferential and longitudinal strains predicted response when dyssynchrony was detected, but failed to identify dyssynchrony in one-third of patients who responded to CRT. Conclusion Dyssynchrony by speckle-tracking echocardiography using radial and transverse strains is associated with EF response and long-term outcome following CRT.</p></abstract><textClass><keywords scheme="keyword"><list><head>keywords</head><item><term>Echocardiography</term></item><item><term>Heart failure</term></item><item><term>Pacing therapy</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2010-06-08">Created</change><change when="2010-07">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/5E58002435C3C9B165EA7ED33FA1E0E13B45E212/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">ehj</journal-id><journal-id journal-id-type="publisher-id">eurheartj</journal-id><journal-title>European Heart Journal</journal-title><issn pub-type="ppub">0195-668X</issn><issn pub-type="epub">1522-9645</issn><publisher><publisher-name>Oxford University Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.1093/eurheartj/ehq213</article-id><article-id pub-id-type="publisher-id">ehq213</article-id><article-categories><subj-group subj-group-type="heading"><subject>FASTTRACK</subject></subj-group><series-title>fasttrack</series-title></article-categories><title-group><article-title>Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy: results of the Speckle Tracking and Resynchronization (STAR) study</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Tanaka</surname><given-names>Hidekazu</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Nesser</surname><given-names>Hans-Joachim</given-names></name><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Buck</surname><given-names>Thomas</given-names></name><xref ref-type="aff" rid="af3">3</xref></contrib><contrib contrib-type="author"><name><surname>Oyenuga</surname><given-names>Olusegun</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Jánosi</surname><given-names>Rolf Alexander</given-names></name><xref ref-type="aff" rid="af3">3</xref></contrib><contrib contrib-type="author"><name><surname>Winter</surname><given-names>Siegmund</given-names></name><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Saba</surname><given-names>Samir</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Gorcsan</surname><given-names>John</given-names><suffix>III</suffix></name><xref ref-type="aff" rid="af1">1</xref><xref ref-type="corresp" rid="cor1">*</xref></contrib></contrib-group><aff id="af1"><label>1</label><institution>University of Pittsburgh</institution>, <addr-line>Scaife Hall 564, 200 Lothrop Street, Pittsburgh, PA</addr-line><addr-line>15213-2582</addr-line>, <country>USA</country></aff><aff id="af2"><label>2</label><institution>Elisabethinen University Teaching Hospital</institution>, <addr-line>Linz</addr-line>, <country>Austria</country></aff><aff id="af3"><label>3</label><institution>University Hospital Essen</institution>, <addr-line>Essen</addr-line>, <country>Germany</country></aff><author-notes><corresp id="cor1"><label>*</label>Corresponding author. Tel: <phone>+1 412 647 6570</phone>, Fax: <fax>+1 412 647 0568</fax>, Email: <email>gorcsanj@upmc.edu</email></corresp></author-notes><pub-date pub-type="ppub"><month>7</month><year>2010</year></pub-date><pub-date pub-type="epub"><day>8</day><month>6</month><year>2010</year></pub-date><volume>31</volume><issue>14</issue><fpage>1690</fpage><lpage>1700</lpage><history><date date-type="received"><day>26</day><month>4</month><year>2010</year></date><date date-type="rev-recd"><day>17</day><month>5</month><year>2010</year></date><date date-type="accepted"><day>31</day><month>5</month><year>2010</year></date></history><permissions><copyright-statement>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2010. For permissions please email: journals.permissions@oxfordjournals.org</copyright-statement><copyright-year>2010</copyright-year><license license-type="creative-commons" xlink:href="http://creativecommons.org/licenses/by-nc/2.0/uk/"><p>The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org</p></license></permissions><abstract><sec><title>Aims</title><p>The Speckle Tracking and Resynchronization (STAR) study used a prospective multi-centre design to test the hypothesis that speckle-tracking echocardiography can predict response to cardiac resynchronization therapy (CRT).</p></sec><sec><title>Methods and results</title><p>We studied 132 consecutive CRT patients with class III and IV heart failure, ejection fraction (EF) ≦35%, and QRS ≥120 ms from three international centres. Baseline dyssynchrony was evaluated by four speckle tracking strain methods; radial, circumferential, transverse, and longitudinal (≥130 ms opposing wall delay for each). Pre-specified outcome variables were EF response and three serious long-term events: death, transplant, or left ventricular assist device. Of 120 patients (91%) with baseline dyssynchrony data, both short-axis radial strain and transverse strain from apical views were associated with favourable EF response 7 ± 4 months and long-term outcome over 3.5 years (<italic>P</italic> < 0.01). Radial strain had the highest sensitivity at 86% for predicting EF response with a specificity of 67%. Serious long-term unfavourable events occurred in 20 patients after CRT, and happened three times more frequently in those who lacked baseline radial or transverse dyssynchrony than in patients with dyssynchrony (<italic>P</italic> < 0.01). Patients who lacked both radial and transverse dyssynchrony had unfavourable clinical events occur in 53%, in contrast to events occurring in 12% if baseline dyssynchrony was present (<italic>P</italic> < 0.01). Circumferential and longitudinal strains predicted response when dyssynchrony was detected, but failed to identify dyssynchrony in one-third of patients who responded to CRT.</p></sec><sec><title>Conclusion</title><p>Dyssynchrony by speckle-tracking echocardiography using radial and transverse strains is associated with EF response and long-term outcome following CRT.</p></sec></abstract><kwd-group><kwd>Echocardiography</kwd><kwd>Heart failure</kwd><kwd>Pacing therapy</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><partName>fasttrack</partName><title>Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy: results of the Speckle Tracking and Resynchronization (STAR) study</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><partName>fasttrack</partName><title>Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy: results of the Speckle Tracking and Resynchronization (STAR) study</title></titleInfo><name type="personal"><namePart type="given">Hidekazu</namePart><namePart type="family">Tanaka</namePart><affiliation>University of Pittsburgh, Scaife Hall 564, 200 Lothrop Street, Pittsburgh, PA15213-2582, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Hans-Joachim</namePart><namePart type="family">Nesser</namePart><affiliation>Elisabethinen University Teaching Hospital, Linz, Austria</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Thomas</namePart><namePart type="family">Buck</namePart><affiliation>University Hospital Essen, Essen, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Olusegun</namePart><namePart type="family">Oyenuga</namePart><affiliation>University of Pittsburgh, Scaife Hall 564, 200 Lothrop Street, Pittsburgh, PA15213-2582, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Rolf Alexander</namePart><namePart type="family">Jnosi</namePart><affiliation>University Hospital Essen, Essen, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Siegmund</namePart><namePart type="family">Winter</namePart><affiliation>Elisabethinen University Teaching Hospital, Linz, Austria</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Samir</namePart><namePart type="family">Saba</namePart><affiliation>University of Pittsburgh, Scaife Hall 564, 200 Lothrop Street, Pittsburgh, PA15213-2582, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">John</namePart><namePart type="family">Gorcsan</namePart><namePart type="termsOfAddress">III</namePart><affiliation>University of Pittsburgh, Scaife Hall 564, 200 Lothrop Street, Pittsburgh, PA15213-2582, USA</affiliation><affiliation>E-mail: gorcsanj@upmc.edu</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>Oxford University Press</publisher><dateIssued encoding="w3cdtf">2010-07</dateIssued><dateCreated encoding="w3cdtf">2010-06-08</dateCreated><copyrightDate encoding="w3cdtf">2010</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Aims The Speckle Tracking and Resynchronization (STAR) study used a prospective multi-centre design to test the hypothesis that speckle-tracking echocardiography can predict response to cardiac resynchronization therapy (CRT). Methods and results We studied 132 consecutive CRT patients with class III and IV heart failure, ejection fraction (EF) 35, and QRS 120 ms from three international centres. Baseline dyssynchrony was evaluated by four speckle tracking strain methods; radial, circumferential, transverse, and longitudinal (130 ms opposing wall delay for each). Pre-specified outcome variables were EF response and three serious long-term events: death, transplant, or left ventricular assist device. Of 120 patients (91) with baseline dyssynchrony data, both short-axis radial strain and transverse strain from apical views were associated with favourable EF response 7 4 months and long-term outcome over 3.5 years (P < 0.01). Radial strain had the highest sensitivity at 86 for predicting EF response with a specificity of 67. Serious long-term unfavourable events occurred in 20 patients after CRT, and happened three times more frequently in those who lacked baseline radial or transverse dyssynchrony than in patients with dyssynchrony (P < 0.01). Patients who lacked both radial and transverse dyssynchrony had unfavourable clinical events occur in 53, in contrast to events occurring in 12 if baseline dyssynchrony was present (P < 0.01). Circumferential and longitudinal strains predicted response when dyssynchrony was detected, but failed to identify dyssynchrony in one-third of patients who responded to CRT. Conclusion Dyssynchrony by speckle-tracking echocardiography using radial and transverse strains is associated with EF response and long-term outcome following CRT.</abstract><subject><genre>keywords</genre><topic>Echocardiography</topic><topic>Heart failure</topic><topic>Pacing therapy</topic></subject><relatedItem type="host"><titleInfo><title>European Heart Journal</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">0195-668X</identifier><identifier type="eISSN">1522-9645</identifier><identifier type="PublisherID">eurheartj</identifier><identifier type="PublisherID-hwp">ehj</identifier><part><date>2010</date><detail type="volume"><caption>vol.</caption><number>31</number></detail><detail type="issue"><caption>no.</caption><number>14</number></detail><extent unit="pages"><start>1690</start><end>1700</end></extent></part></relatedItem><identifier type="istex">5E58002435C3C9B165EA7ED33FA1E0E13B45E212</identifier><identifier type="DOI">10.1093/eurheartj/ehq213</identifier><identifier type="ArticleID">ehq213</identifier><accessCondition type="use and reproduction" contentType="copyright">Published on behalf of the European Society of Cardiology. 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