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CARDIAC RESYNCHRONIZATION THERAPY: COMMENTARY

Echocardiography for Cardiac Resynchronization Therapy Selection

Fatally Flawed or Misjudged?

Department of Cardiovascular Medicine, University of Birmingham, Birmingham, United Kingdom

Manuscript received November 10, 2008; revised manuscript received December 8, 2008, accepted December 18, 2008.

^_* Reprint requests and correspondence: Prof. John E. Sanderson, Department of Cardiovascular Medicine, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom (Email: j.e.sanderson{at}bham.ac.uk).

After the publication of the PROSPECT (Predictors of Response to CRT) trial, the use of echocardiography for the assessment of mechanical dyssynchrony and as a possible aid for selecting patients for cardiac resynchronization therapy has been heavily criticized. Calls have been made to observe the current guidelines and implant according to the entry criteria of recent major trials. However, although this approach is currently to be recommended, the attempt to identify patients who will not receive the benefits of cardiac resynchronization therapy and whose clinical condition may be worsened should continue. Devices are not analogous to drugs: initial costs are higher, complications are significant, and the device cannot readily be withdrawn. Professional resources and the costs to society are high and wasted if devices are implanted inappropriately. Rather that discarding the attempt to identify the most suitable patients pre-operatively, further work is needed to refine the techniques and new clinical trials performed. A combination of methods that include finding the site of latest mechanical activation, myocardial scar localization, and assessing venous anatomy pre-operatively may help to identify those who will not derive any benefit or be potentially worsened.

Key Words: cardiac resynchronization therapy • heart failure • dyssynchrony • tissue Doppler imaging

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   CRT = cardiac resynchronization therapy   LBBB = left bundle branch block   LV = left ventricle/ventricular   LVEF = left ventricular ejection fraction   NYHA = New York Heart Association   TDI = tissue Doppler imaging

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				D. Schaber Clarification and Correction About the Design and Implementation of the PROSPECT Trial. J. Am. Coll. Cardiol., December 1, 2009; 54(23): 2203 - 2204. [Full Text] [PDF]