Key result
Echocardiographic assessment of typical left bundle branch block contraction patterns, septal flash, and apical rocking provides more clinical utility for predicting response to cardiac resynchronization therapy than conventional time-to-peak dyssynchrony methods.
Why the study?
Predicting response to CRT remains challenging, as nearly one-third of patients gain no benefit, and trials using mechanical dyssynchrony as criteria failed to improve CRT response.
Current echocardiographic measures of mechanical dyssynchrony are insufficient alone to predict CRT response, necessitating more advanced imaging approaches to understand cardiac mechanics.
The role of electromechanical dyssynchrony in heart failure gained prominence in literature with the results of trials of cardiac resynchronization therapy (CRT). CRT has shown to significantly decrease heart failure hospitalization and mortality in heart failure patients with dyssynchrony. Current guidelines recommend the use of electrical dyssynchrony based on a QRS > 150 ms and a left bundle branch block pattern on surface electrocardiogram to identify dyssynchrony in patients who will benefit from CRT implantation. However, predicting response to CRT remains a challenge with nearly one-third of patients gaining no benefit from the device. Multiple echocardiographic measures of mechanical dyssynchrony have been studied over the past two decade. However, trials where mechanical dyssynchrony used as an additional or lone criteria for CRT failed to show any benefit in the response to CRT. This shows that a deeper understanding of cardiac mechanics should be applied in the assessment of dyssynchrony. This review discusses the evolving role of imaging techniques in assessing cardiac dyssynchrony and their application in patients considered for device therapy.
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Satish et al. (2022) conducted a review in Heart failure. Cardiac resynchronization therapy (CRT) was evaluated. Echocardiographic assessment of typical left bundle branch block contraction patterns, septal flash, and apical rocking provides more clinical utility for predicting response to cardiac resynchronization therapy than conventional time-to-peak dyssynchrony methods.
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