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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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