LV Dyssynchrony and Resynchronization Therapy

LV Dyssynchrony and Resynchronization Therapy
LV Dyssynchrony and Resynchronization Therapy
1. Heart failure patients with depressed ejection fractions
and with which of the following have the greatest level of
evidence of response to cardiac resynchronization therapy
(CRT)?
A. QRS width ≥150 ms regardless of QRS morphology
B. QRS width ≥120 ms and left bundle branch block
C. QRS width ≥150 ms and right bundle branch block
D. QRS width ≥150 ms and left bundle branch block
2. Which echocardiographic technique to determine dyssynchrony is the most reproducible and most widely available
on all echocardiographic equipment?
A. Tissue Doppler velocity Yu index
B. Tissue Doppler longitudinal strain delay
C. Speckle tracking radial strain delay
D. Interventricular mechanical delay
3. Intraventricular dyssynchrony can be assessed by the time
to peak tissue Doppler longitudinal velocity curve. Which
technical approach will give the most reproducible velocity signal?
A. Pulsed tissue Doppler in the midseptum and midlateral
wall
B. Color-coded tissue Doppler with a 3-mm circular
region of interest at base or midlevels
C. Color-coded tissue Doppler with a 5-mm × 7-mm
region of interest at base or midlevels
D. Color-coded tissue Doppler with a 5-mm circular
region of interest at the apical level
4. The 12-site standard deviation in time to peak tissue
Doppler velocities, also known as the Yu index shown
in Figure 33.1, has been shown to be an important
measure of dyssynchrony associated with cardiac resynchronization therapy. Which of the following statements
is true?
A. Velocity cannot differentiate between active
contraction and passive motion.
B. Tissue Doppler has a stronger signal-to-noise ratio
than speckle tracking.
C. Determination of peak velocities used for the Yu index
requires training and experience.
D. The Yu index was shown to have low yield in the
PROSPECT study.
E. All of the above.
Chapter 33
LV Dyssynchrony and
Resynchronization Therapy
John Gorcsan III and Mohamed Ahmed
Figure 33.1
(c) 2015 Wolters Kluwer. All Rights Reserved.
Chapter 33 LV Dyssynchrony and Resynchronization Therapy 291
Figure 33.2
5. Baseline dyssynchrony detected by which of the following methods has been associated with long-term survival
after cardiac resynchronization therapy?
A. Tissue Doppler longitudinal strain
B. Tissue Doppler longitudinal tissue tracking
C. Speckle tracking longitudinal strain rate
D. Speckle tracking radial strain
6. Of the following technical tips associated with speckle
tracking radial strain acquisition and analysis, which is
the least correct?
A. Image gain and contrast should be set to optimize
visualization of wall motion.
B. Frame rates should be set at least 120 Hz.
C. The region of interest needs to be adjusted to track the
endocardium.
D. Because of beat-to-beat variability, three or more beats
should be analyzed, even in normal sinus rhythm.
7. A 63-year-old male undergoes cardiac resynchronization
therapy and returns to the echocardiography laboratory
after 3 months for atrioventricular (AV) optimization
because of continued dyspnea. His AV delay was set at
120 ms at the time of implantation, and his baseline mitral
inŠow pulsed Doppler pattern appears in Figure 33.2A.
Using the iterative technique, AV delay was increased from
120 to 160 ms, then to 200 ms, as shown in Figure 33.2B.
The most likely explanation for these Žndings is:
A. Intra-atrial conduction delay
B. Dislodged right atrial lead
C. Loss of biventricular pacing capture
D. Persistent atrial Žbrillation
8. In addition to nonresponders to cardiac resynchronization
implantation, which of the following patient subgroups
appears to derive the most beneŽt from atrioventricular
optimization?
A. Patients with echo-guided lead positioning
B. Women with nonischemic cardiomyopathy
C. Men with ischemic cardiomyopathy
D. Patients on beta blocker therapy
9. A 58-year-old female has marked improvement in her
symptoms of heart failure after cardiac resynchronization therapy (CRT). In addition to an improvement in
ejection fraction, a decrease in her mitral regurgitation
was observed, as shown in Figure 33.3. Which of the
following has been mechanistically associated with reduction in mitral regurgitation after CRT?
A. Increases in mitral leaŠet tenting angle
B. Decreases in the degree of mitral valve prolapse
C. Increases in reverse remodeling of papillary muscle
scar
D. Decreases in the timing of papillary muscle closing
forces
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