Qualitative Observation of Left Ventricular Multiphasic Septal Motion and Septal-to-Lateral Apical Shuffle Predicts Left Ventricular Reverse Remodeling After Cardiac Resynchronization Therapy

A multiphasic septal motion and typical septal-to-lateral apical shuffle of the left ventricle can be observed echocardiographically in some patients with left branch bundle block. The relation of both with left ventricular (LV) dyssynchrony according to tissue Doppler and LV reverse remodeling after cardiac resynchronization therapy was investigated. Fifty-three patients (37 men; age 68 ± 8 years) with ischemic (n = 26) or idiopathic (n = 27) cardiomyopathy, baseline QRS duration 171 ± 30 ms, LV ejection fraction 21 ± 7%, and LV end-diastolic volume 257 ± 91 ml were studied. LV dyssynchrony using tissue Doppler was considered present if the SD of the interval between QRS and onset of systolic velocity of 6 basal LV segments was >20 ms. Shuffle was evaluated visually independently by 5 cardiologists and considered present if observed in ≥1 view. LV reverse remodeling, defined as LV end-systolic volume decrease ≥10%, was observed in 37 patients (70%) after 3 months of CRT. Sensitivity and specificity of either shuffle or multiphasic septal motion for all 5 observers (range 90% to 97% and 67% to 83%, respectively) were found to predict LV dyssynchrony. To predict LV reverse remodeling, sensitivity and specificity from 87% to 92% and 69% to 81% were observed, respectively. In conclusion, the qualitative observation of a typical shuffle or multiphasic septal motion predicts LV dyssynchrony and LV reverse remodeling adequately.