Additive Value of Right Ventricular Dyssynchrony Indexes in Predicting the Success of Cardiac Resynchronization Therapy: A Speckle-Tracking Imaging Study ANTONIO VITARELLI, MD, FACC, PASQUALE FRANCIOSA, MD, BICH LIEN NGUYEN, MD, LIDIA CAPOTOSTO, MD, ANTONIO CICCAGLIONI, MD, YSABEL CONDE, MD, GIUSEPPE IORIO, MD, GUGLIELMO DE CURTIS, MD, FIORELLA CARANCI, MD, MASSIMO VITARELLI, MD, PIETRO LUCCHETTI, MD, OLGA DETTORI, MD, AND VALENTINA DE CICCO, MD Rome, Italy ABSTRACT Background: The purpose of our study was to analyze the evolution of left and right ventricular (LV, RV) parameters before and after cardiac resynchronization therapy (CRT) using speckle-tracking imaging (STI). Methods and Results: Eighty-one patients with dilated cardiomyopathy (New York Heart Association functional class III or IV), left bundle branch block (QRS $120 ms), and LV ejection fraction #35% were studied with STI echocardiography before and after CRT. LV longitudinal (LV-SD12-l), radial (LV-SD6-r), and circumferential (LV-SD6-c) intraventricular dyssynchrony and LV twist (LV-t) were de- termined. RV dyssynchrony (RV-SD6) was defined as the standard deviation of the 6 time to peak systolic strain values. At 6 months’ follow-up after CRT, the degree of dyssynchrony correlated significantly with LV ejection fraction improvement and end-systolic volume reduction. In receiver operating characteristic curve analysis, the following variables predictive of successful CRTwere obtained: LV-SD12-l (area under the curve [AUC] 0.69), LV-SD6-c (AUC 0.66), LV-SD6-r (AUC 0.79), LV-t (AUC 0.81), and RV-SD6þLV- SD6-r (AUC 0.83). By combining LVand RV intraventricular dyssynchrony (LV-SD12-l þ LV-SD6-r þ RV-SD6), the AUC was significantly improved to 0.89 (P ! .005 compared with RV-SD6þLV-SD6-r; P ! .001 compared with LV-t). Conclusions: Our data show that assessment of RV dyssynchrony parameters has an incremental value in the evaluation of candidates for CRTand may supplement LV dyssynchrony information. (J Cardiac Fail 2011;17:392e402) Key Words: Echocardiography, speckle-tracking imaging, right ventricular function, right ventricular dyssynchrony, cardiac resynchronization therapy. Cardiac resynchronization therapy (CRT) has been proven to achieve reverse left ventricular (LV) remodeling in patients with advanced heart failure, but w30%e40% nonresponse has been reported. 1 Complex mechanical al- teration in a dyssynchronous ventricle is probably one of the reasons for a lack of response to CRT. LV longitudinal contraction data detecting ventricular dyssyn- chrony have been derived by Doppler echocardiographic methods, 2e4 and further alterations in the radial and rota- tional mechanics as assessed by speckle-tracking imaging (STI) have been shown to have potential for predicting re- sponders to CRT. 5e13 Right ventricular (RV) dysfunction also has been reported to have a role in candidates for CRT, 14,15 and RV segmental heterogeneity and dyssyn- chrony have been described in pulmonary arterial hyper- tension, 16,17 but studies of the relationships between LV dyssynchrony and RV dysfunction and dyssynchrony in patients with dilated cardiomyopathy are scant. 18,19 The aim of the present study was to analyze whether alter- ations in longitudinal, radial and rotational mechanics as assessed by STI could add new insights into LV as well as RV dyssynchrony in heart failure patients. From the Sapienza University, Rome, Italy. Manuscript received September 21, 2010; revised manuscript received November 24, 2010; revised manuscript accepted December 22, 2010. Reprint requests: Antonio Vitarelli, MD, Via Lima 35, 00198 Rome, Italy. Tel: þ39-6-85301427; Fax: þ39-6-8841926. E-mail: vitar@tiscali.it Presented in part at the Heart Failure 2009 Meeting, May 30eJune 2, 2009, Nice, France. See page 400 for disclosure information. 1071-9164/$ - see front matter Ó 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.cardfail.2010.12.004 392 Journal of Cardiac Failure Vol. 17 No. 5 2011