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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
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STATE-OF-THE-ART PAPER

Cardiac Resynchronization Therapy

Part 1—Issues Before Device Implantation

Jeroen J. Bax, MD*,*, Theodore Abraham, MD, FACC{dagger}, S. Serge Barold, MD, FACC{ddagger}, Ole A. Breithardt, MD§, Jeffrey W.H. Fung, MD||, Stephane Garrigue, MD, PhD, John Gorcsan, III, MD, FACC#, David L. Hayes, MD, FACC**, David A. Kass, MD{dagger}, Juhani Knuuti, MD, PhD{dagger}{dagger}, Christophe Leclercq, MD, PhD{ddagger}{ddagger}, Cecilia Linde, MD, PhD§§, Daniel B. Mark, MD, PhD, FACC||||, Mark J. Monaghan, PhD¶¶, Petros Nihoyannopoulos, MD, FRCP, FACC, FESC***, Martin J. Schalij, MD*, Christophe Stellbrink, MD{dagger}{dagger}{dagger} and Cheuk-Man Yu, MD||

* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
{dagger} Johns Hopkins University, Baltimore, Maryland
{ddagger} 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
{dagger}{dagger} Turku PET Center, University of Turku, Turku, Finland
{ddagger}{ddagger} 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
{dagger}{dagger}{dagger} 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.

Abbreviations and Acronyms
  CMR = cardiovascular magnetic resonance
  CRT = cardiac resynchronization therapy
  LV = left ventricle/ventricular
  LVEF = left ventricular ejection fraction
  MIRACLE = Multicenter InSync Randomized Clinical Evaluation study
  MSCT = multislice computed tomography
  NYHA = New York Heart Association
  TDI = tissue Doppler imaging
  TSI = tissue synchronization imaging




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Heart, March 1, 2007; 93(3): 403 - 408.
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CirculationHome page
P. Knaapen, T. Germans, J. Knuuti, W. J. Paulus, P. A. Dijkmans, C. P. Allaart, A. A. Lammertsma, and F. C. Visser
Myocardial Energetics and Efficiency: Current Status of the Noninvasive Approach
Circulation, February 20, 2007; 115(7): 918 - 927.
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EuropaceHome page
O. I.I. Soliman, D. A.M.J. Theuns, M. L. Geleijnse, A. M. Anwar, A. Nemes, K. Caliskan, W. B. Vletter, L. J. Jordaens, and F. J. T. Cate
Spectral pulsed-wave tissue Doppler imaging lateral-to-septal delay fails to predict clinical or echocardiographic outcome after cardiac resynchronization therapy
Europace, February 1, 2007; 9(2): 113 - 118.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
C.-M. Yu, Q. Zhang, G. W.K. Yip, P.-W. Lee, L. C.C. Kum, Y.-Y. Lam, and J. W.-H. Fung
Diastolic and Systolic Asynchrony in Patients With Diastolic Heart Failure: A Common But Ignored Condition
J. Am. Coll. Cardiol., January 2, 2007; 49(1): 97 - 105.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
J. Wang, K. M. Kurrelmeyer, G. Torre-Amione, and S. F. Nagueh
Systolic and Diastolic Dyssynchrony in Patients With Diastolic Heart Failure and the Effect of Medical Therapy
J. Am. Coll. Cardiol., January 2, 2007; 49(1): 88 - 96.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
C.-M. Yu, Y.-S. Chan, Q. Zhang, G. W.K. Yip, C.-K. Chan, L. C.C. Kum, L. Wu, A. P.-W. Lee, Y.-Y. Lam, and J. W.-H. Fung
Benefits of Cardiac Resynchronization Therapy for Heart Failure Patients With Narrow QRS Complexes and Coexisting Systolic Asynchrony by Echocardiography
J. Am. Coll. Cardiol., December 5, 2006; 48(11): 2251 - 2257.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
J. E. Sanderson
QRS duration alone to select patients for cardiac resynchronization therapy: flying in the face of the evidence? reply
Eur. Heart J., December 2, 2006; 27(24): 3075 - 3075.
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J Am Coll CardiolHome page
J. D. Thomas and Z. B. Popovic
Assessment of Left Ventricular Function by Cardiac Ultrasound
J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2012 - 2025.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
N. R. Van de Veire, J. D. Schuijf, J. De Sutter, D. Devos, G. B. Bleeker, A. de Roos, E. E. van der Wall, M. J. Schalij, and J. J. Bax
Non-Invasive Visualization of the Cardiac Venous System in Coronary Artery Disease Patients Using 64-Slice Computed Tomography
J. Am. Coll. Cardiol., November 7, 2006; 48(9): 1832 - 1838.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
S. A.F. Tulner, J. J. Bax, G. B. Bleeker, P. Steendijk, R. J.M. Klautz, E. R. Holman, M. J. Schalij, R. A.E. Dion, and E. E. van der Wall
Beneficial Hemodynamic and Clinical Effects of Surgical Ventricular Restoration in Patients With Ischemic Dilated Cardiomyopathy
Ann. Thorac. Surg., November 1, 2006; 82(5): 1721 - 1727.
[Abstract] [Full Text] [PDF]


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JNMHome page
C. Ypenburg, M. J. Schalij, G. B. Bleeker, P. Steendijk, E. Boersma, P. Dibbets-Schneider, M. P. Stokkel, E. E. van der Wall, and J. J. Bax
Extent of Viability to Predict Response to Cardiac Resynchronization Therapy in Ischemic Heart Failure Patients
J. Nucl. Med., October 1, 2006; 47(10): 1565 - 1570.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
J. J. Bax
Reply
J. Am. Coll. Cardiol., August 1, 2006; 48(3): 592 - 592.
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Eur Heart JHome page
H. Mannaerts
Regression of left ventricular mass and wall thickness after cardiac resynchronization therapy: proof of pathophysiological concept
Eur. Heart J., June 2, 2006; 27(12): 1392 - 1393.
[Full Text] [PDF]


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Eur Heart JHome page
N. M. Hawkins, M. C. Petrie, M. R. MacDonald, K. J. Hogg, and J. J.V. McMurray
Selecting patients for cardiac resynchronization therapy: electrical or mechanical dyssynchrony?
Eur. Heart J., June 1, 2006; 27(11): 1270 - 1281.
[Abstract] [Full Text] [PDF]



 
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