Echocardiography for prediction of 6-month and late response to cardiac resynchronization therapy: implementation of stress echocardiography and comparative assessment along with widely used dyssynchrony indices

  • Emmanouil PoulidakisEmail author
  • Constantina Aggeli
  • Skevos Sideris
  • Eliza Sfendouraki
  • Iosif Koutagiar
  • Andreas Katsaros
  • Evangelos Giannoulis
  • Markos Koukos
  • Eleni Margioula
  • Stavroula Lagoudakou
  • Kostas Gatzoulis
  • Polychronis Dilaveris
  • Ioannis Kallikazaros
  • Stavroula Couloheri
  • Christodoulos Stefanadis
  • Dimitrios Tousoulis
Original Paper


Non-response cardiac resynchronization therapy (CRT) remains an issue, despite the refinement of selection criteria. The purpose of this study was to investigate the role of stress echocardiography along with dyssynchrony parameters for identification of CRT responders or late responders. 106 symptomatic heart failure patients were examined before, 6 months and 2–4 years after CRT implementation. Inotropic contractile reserve (ICR) and inferolateral (IL) wall viability were studied by stress echocardiography. Dyssynchrony was assessed by: (1) Septal to posterior wall motion delay (SPWMD) by m-mode. (2) Septal to lateral wall delay (SLD) by TDI. (3) Interventricular mechanical delay (IVMD) by pulsed wave Doppler for (4) difference in time to peak circumferential strain (TmaxCS) by speckle tracking. (5) Apical rocking (ApR) and septal flash (SF) by visual assessment. At 6 months there were 54 responders, with 12 additional late responders. TmaxCS had the greatest predictive value with an area under curve (AUC) of 0.835, followed by the presence of both ICR and viability of IL wall (AUC 0.799), m-mode (AUC = 0.775) and presence of either ApR or SF (AUC = 0.772). Predictive ability of ApR and of ICR is augmented if late responders are also included. Performance of dyssynchrony parameters is enhanced, in patients with both ICR and IL wall viability. Stress echocardiography and dyssynchrony parameters are simple and reliable predictors of 6-month and late CRT response. A stepwise approach with an initial assessment of ICR and viability and, if positive, further dyssynchrony analysis, could assist decision making.


Cardiac resynchronization therapy Dyssynchrony Stress echocardiography Heart failure 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Emmanouil Poulidakis
    • 1
    • 6
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  • Constantina Aggeli
    • 2
  • Skevos Sideris
    • 3
  • Eliza Sfendouraki
    • 3
  • Iosif Koutagiar
    • 2
  • Andreas Katsaros
    • 4
  • Evangelos Giannoulis
    • 1
  • Markos Koukos
    • 1
  • Eleni Margioula
    • 1
  • Stavroula Lagoudakou
    • 2
  • Kostas Gatzoulis
    • 2
  • Polychronis Dilaveris
    • 2
  • Ioannis Kallikazaros
    • 1
  • Stavroula Couloheri
    • 5
  • Christodoulos Stefanadis
    • 2
  • Dimitrios Tousoulis
    • 2
  1. 1.Department of CardiologyEvagelismos General Hospital of AthensAthensGreece
  2. 2.First Cardiology Clinic, Hippokration HospitalUniversity of AthensAthensGreece
  3. 3.Cardiology DepartmentHippokration HospitalAthensGreece
  4. 4.Cardiosurgery DepartmentHippokration HospitalAthensGreece
  5. 5.Department of Biological Chemistry, Medical SchoolUniversity of AthensAthensGreece
  6. 6.Hôpital Européen Georges-PompidouParisFrance

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