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J Am Coll Cardiol, 2005; 46:2153-2167, doi:10.1016/j.jacc.2005.09.019 © 2005 by the American College of Cardiology Foundation |
* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Johns Hopkins University, Baltimore, Maryland
University of South Florida, Tampa, Florida
University of Klinikum Mannheim, Mannheim, Germany
|| The Chinese University of Hong Kong, Hong Kong, China
¶ Hopital Cardiologique du Haut-Leveque, Pessac, France
# University of Pittsburgh, Pittsburgh, Pennsylvania
** Mayo Clinic, Rochester, Minnesota
Turku PET Center, University of Turku, Turku, Finland
Hopital Pontchaillou, Rennes, France
Karolinska University Hospital, Stockholm, Sweden
|||| Duke Clinical Research Institute, Durham, North Carolina
¶¶ King’s College Hospital, London, United Kingdom
*** Hammersmith Hospital, London, United Kingdom
Stadtische Kliniken Bielefeld, Bielefeld, Germany
Manuscript received April 19, 2005; revised manuscript received September 19, 2005, accepted September 19, 2005.
* Reprint requests and correspondence: Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands. (Email: jbax{at}knoware.nl).
Cardiac resynchronization therapy (CRT) has been used extensively over the last years in the therapeutic management of patients with end-stage heart failure. Data from 4,017 patients have been published in eight large, randomized trials on CRT. Improvement in clinical end points (symptoms, exercise capacity, quality of life) and echocardiographic end points (systolic function, left ventricular size, mitral regurgitation) have been reported after CRT, with a reduction in hospitalizations for decompensated heart failure and an improvement in survival. However, individual results vary, and 20% to 30% of patients do not respond to CRT. At present, the selection criteria include severe heart failure (New York Heart Association functional class III or IV), left ventricular ejection fraction <35%, and wide QRS complex (>120 ms). Assessment of inter- and particularly intraventricular dyssynchrony as provided by echocardiography (predominantly tissue Doppler imaging techniques) may allow improved identification of potential responders to CRT. In this review a summary of the clinical and echocardiographic results of the large, randomized trials is provided, followed by an extensive overview on the currently available echocardiographic techniques for assessment of LV dyssynchrony. In addition, the value of LV scar tissue and venous anatomy for the selection of potential candidates for CRT are discussed.
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