What does this research mean for the field?

New echocardiographic indices of electromechanical dyssynchrony, such as septal flash and apical rocking, provide a mechanistic approach that improves patient selection for cardiac resynchronization therapy, particularly in those with intermediate QRS duration. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

Evaluate modern echocardiographic approaches and novel electromechanical indices for improving candidate selection in cardiac resynchronization therapy.

August 25, 2016Echocardiography

Role of echocardiography before cardiac resynchronization therapy: new advances and current developments

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Why the study?

Do new echocardiographic indices of electromechanical dyssynchrony improve the prediction of response to CRT?

Population

Patients being evaluated for cardiac resynchronization therapy, particularly those with intermediate QRS width

Comparison

New echocardiographic indices of… vs Classical assessment of LV mechanical…

Design

Review

Authors

SMSylvestre MaréchauxCardiac Imaging AMAymeric MenetUniversité Catholique de Lille YGYves GuyomarElectrophysiology

Discussion

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Implication

May aid CRT selection in intermediate QRS; leaves open prospective validation before practice change.

Key Points

Evaluate modern echocardiographic approaches and novel electromechanical indices for improving candidate selection in cardiac resynchronization therapy.
Reviewed limitations of traditional left ventricular mechanical wall-delay measurements from previous landmark reports and multicenter trials.
Analyzed mechanistic echocardiographic markers of electromechanical dyssynchrony across different QRS duration strata.
Classical left ventricular wall delays inconsistently predict response because they reflect loading conditions and regional contractility rather than true electrical activation delay.
Novel electromechanical markers—including septal flash, apical rocking, and typical left bundle branch block strain patterns—occur rarely with narrow QRS (<120 ms) and increase in frequency with QRS >120 ms.
These mechanistic markers offer particular clinical utility in identifying responders among candidates with intermediate QRS durations between 120 and 150 ms.

Structured PICO

Do new echocardiographic indices of electromechanical dyssynchrony improve the prediction of response to CRT?

Population

Patients being evaluated for cardiac resynchronization therapy (CRT), particularly those with intermediate QRS width (120-150 ms)

Intervention

New echocardiographic indices of electromechanical dyssynchrony (septal flash, LBBB-typical pattern by longitudinal strain, apical rocking, septal strain patterns, and systolic stretch index)

Comparator

Classical assessment of LV mechanical dyssynchrony using delay between walls

Outcome

Prediction of LV response and outcome after CRTsurrogate

New echocardiographic indices of electromechanical dyssynchrony offer a mechanistic approach to better select candidates for CRT, particularly when QRS duration is intermediate.

Cite This Study

Maréchaux et al. (2016) studied this question.

synapsesocial.com/papers/6a1be50769a4af5b15a922bc https://doi.org/10.1111/echo.13334

Topics

Echocardiography

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Role of echocardiography before cardiac resynchronization therapy: new advances and current developments

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Role of echocardiography before cardiac resynchronization therapy: new advances and current developments

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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