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J Am Coll Cardiol, 2004; 44:1-9, doi:10.1016/j.jacc.2004.02.055
© 2004 by the American College of Cardiology Foundation
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STATE-OF-THE-ART PAPER

Echocardiographic evaluation of cardiac resynchronization therapy: ready for routine clinical use?

A critical appraisal

Jeroen J. Bax, MD, PhD*,*, Gerardo Ansalone, MD{dagger}, Ole A. Breithardt, MD{ddagger}, Genevieve Derumeaux, MD§, Christophe Leclercq, MD||, Martin J. Schalij, MD, PhD*, Peter Sogaard, MD, Martin St. John Sutton, MD# and Petros Nihoyannopoulos, MD, FRCP, FACC**

* Leiden University Medical Center, Leiden, the Netherlands
{dagger} San Filippo Neri Hospital Rome, Rome, Italy
{ddagger} University Hospital Aachen, Aachen, Germany
§ Rouen University, Rouen, France
|| Hopital Pontchaillou, Rennes, France
Skejby Hospital, Aarhus, Denmark
# University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
** Imperial College, NHLI, Hammersmith Hospital, London, United Kingdom

Manuscript received November 28, 2003; revised manuscript received January 28, 2004, accepted February 10, 2004.

* Reprint requests and correspondence: Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
jbax{at}knoware.nl

Cardiac resynchronization therapy (CRT) has been proposed as an alternative treatment in patients with severe, drug-refractory heart failure. The clinical results are promising, and improvement in symptoms, exercise capacity, and systolic left ventricular (LV) function have been demonstrated after CRT, accompanied by a reduction in hospitalization and a superior survival as compared with optimized medical therapy alone. However, 20% to 30% of patients do not respond to CRT. Currently, patients are selected mainly on electrocardiogram criteria (wide QRS complex, left bundle branch block configuration). In view of the 20% to 30% of nonresponders, additional selection criteria are needed. Echocardiography (and, in particular, tissue Doppler imaging) may allow further identification of potential responders to CRT, based on assessment of inter- and intraventricular dyssynchrony. In addition, echocardiography may allow optimal LV lead positioning and follow-up after CRT. In the current review, the different echocardiographic approaches to predict response to CRT are discussed. In addition, the use of echocardiography to guide LV lead positioning and follow-up after CRT are addressed.

Abbreviations and Acronyms
  AV = atrioventricular
  CRT = cardiac resynchronization therapy
  IVMD = interventricular mechanical delay
  LV = left ventricle/ventricular
  LVEF = left ventricular ejection fraction
  NYHA = New York Heart Association
  SPWMD = septal-to-posterior wall motion delay
  TDI = tissue Doppler imaging
  TT = tissue tracking




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J Am Coll CardiolHome page
A. B. Curtis
Cardiac resynchronization therapy 101: If it's not late, pacing it early won't help
J. Am. Coll. Cardiol., January 4, 2005; 45(1): 70 - 71.
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J Am Coll CardiolHome page
J. Gorcsan III, R. M. Lang, M. H. Picard, W. A. Zoghbi, P. C. Frommelt, and L. D. Gillam
Meeting highlights of the 15th annual Scientific Sessions of the American Society of Echocardiography: June 26 to 30, 2004
J. Am. Coll. Cardiol., December 7, 2004; 44(11): 2111 - 2116.
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J Am Coll CardiolHome page
J. J. Bax, G. B. Bleeker, T. H. Marwick, S. G. Molhoek, E. Boersma, P. Steendijk, E. E. van der Wall, and M. J. Schalij
Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy
J. Am. Coll. Cardiol., November 2, 2004; 44(9): 1834 - 1840.
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Am. J. Respir. Crit. Care Med.Home page
C. A. McPherson and C. Manthous
Permanent Pacemakers and Implantable Defibrillators: Considerations for Intensivists
Am. J. Respir. Crit. Care Med., November 1, 2004; 170(9): 933 - 940.
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