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 ,
Ole A. Breithardt, MD ,
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
San Filippo Neri Hospital Rome, Rome, Italy
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.
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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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C.-M. Yu, G. B. Bleeker, J. W.-H. Fung, M. J. Schalij, Q. Zhang, E. E. van der Wall, Y.-S. Chan, S.-L. Kong, and J. J. Bax
Left Ventricular Reverse Remodeling but Not Clinical Improvement Predicts Long-Term Survival After Cardiac Resynchronization Therapy
Circulation,
September 13, 2005;
112(11):
1580 - 1586.
[Abstract]
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S. Kapetanakis, M.T. Kearney, A. Siva, N. Gall, M. Cooklin, and M.J. Monaghan
Real-Time Three-Dimensional Echocardiography: A Novel Technique to Quantify Global Left Ventricular Mechanical Dyssynchrony
Circulation,
August 16, 2005;
112(7):
992 - 1000.
[Abstract]
[Full Text]
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A. Kadish and M. Mehra
Heart Failure Devices: Implantable Cardioverter-Defibrillators and Biventricular Pacing Therapy
Circulation,
June 21, 2005;
111(24):
3327 - 3335.
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R. H. Helm, C. Leclercq, O. P. Faris, C. Ozturk, E. McVeigh, A. C. Lardo, and D. A. Kass
Cardiac Dyssynchrony Analysis Using Circumferential Versus Longitudinal Strain: Implications for Assessing Cardiac Resynchronization
Circulation,
May 31, 2005;
111(21):
2760 - 2767.
[Abstract]
[Full Text]
[PDF]
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S. A. Strickberger, J. Conti, E. G. Daoud, E. Havranek, M. R. Mehra, I. L. Pina, J. Young, and Endorsed by the American College of Cardiology Fou
Patient Selection for Cardiac Resynchronization Therapy: From the Council on Clinical Cardiology Subcommittee on Electrocardiography and Arrhythmias and the Quality of Care and Outcomes Research Interdisciplinary Working Group, in Collaboration With the Heart Rhythm Society
Circulation,
April 26, 2005;
111(16):
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[Abstract]
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J. A. Jarcho
Resynchronizing Ventricular Contraction in Heart Failure
N. Engl. J. Med.,
April 14, 2005;
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A. E. Weyman
The year in echocardiography
J. Am. Coll. Cardiol.,
February 1, 2005;
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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):
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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;
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[Abstract]
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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):
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[Abstract]
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C. A. McPherson and C. Manthous
Permanent Pacemakers and Implantable Defibrillators: Considerations for Intensivists
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[Abstract]
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