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European Journal of Echocardiography Advance Access published online on June 23, 2009
European Journal of Echocardiography, doi:10.1093/ejechocard/jep091
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Large response to cardiac resynchronization therapy in a patient with segmental paradoxical systolic expansion identified by strain imaging

Hidekazu Tanaka, Hiroya Kawai*, Kazuhiro Tatsumi, Toshiya Kataoka, Tetsuari Onishi, Akihiro Yoshida and Ken-ichi Hirata

Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan

Received 11 March 2009; accepted after revision 31 May 2009.

* Corresponding author. Tel: +81 78 382 5846; fax: +81 78 382 5859. E-mail address: hkawai{at}med.kobe-u.ac.jp


  Abstract

An 84-year-old man with non-ischaemic cardiomyopathy underwent cardiac resynchronization therapy (CRT) based on the presence of drug-refractory heart failure, depressed left ventricular ejection fraction (25%), and wide QRS complex (160 ms). Longitudinal tissue velocity revealed no significant dyssynchrony (23 ms in Yu index and 35 ms in opposing wall delay). However, longitudinal tissue Doppler strain revealed unique appearances in apical four-chamber and long-axis views. The anterior and inferior septum at basal and mid-levels had reversed strain (becoming positive), indicating paradoxical systolic expansion. Ejection fraction dramatically improved from 26 to 50% the day following CRT, and this beneficial effect of CRT was sustained 12 months following CRT. The presence of the segmental reversed strain might have a potential to predict a large response to CRT in the assessment of longitudinal dyssynchrony.

Keywords: Echocardiography; Tissue Doppler imaging; Pacing therapy


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