Key result
Echocardiographic techniques like tissue Doppler imaging offer higher predictive value for cardiac resynchronization therapy response but are technically complex and require training.
Why the study?
Do echocardiographic techniques to quantify regional dyssynchrony improve patient selection and response rate to cardiac resynchronization therapy in patients with severe symptomatic heart failure, wide QRS duration, and depressed left ventricular ejection fraction?
Do echocardiographic techniques to quantify regional dyssynchrony improve patient selection and response rate to cardiac resynchronization therapy in patients with severe symptomatic heart failure, wide QRS duration, and depressed left ventricular ejection fraction?
Echocardiographic techniques, particularly tissue Doppler imaging, show promise in identifying mechanical dyssynchrony to improve patient selection for CRT, though further data are needed to define their appropriate clinical role.
May refine CRT selection in expert centers; leaves open routine use pending prospective validation.
PURPOSE OF REVIEW: Cardiac resynchronization therapy is a great benefit to many patients with severe symptomatic heart failure, wide QRS duration, and depressed left ventricular ejection fraction. Although the widened QRS is a surrogate for delayed mechanical activation, known as dyssynchrony, imaging techniques have identified a subset of patients with widened QRS who do not have dyssynchrony and accordingly do not respond to cardiac resynchronization therapy. RECENT FINDINGS: Many echocardiographic techniques have emerged to quantify regional dyssynchrony, in hopes of improving patient selection and response rate to cardiac resynchronization therapy. Principal methods include M-mode septal to posterior wall motion delay, pulsed Doppler measures of left ventricular ejection in relation to right ventricular ejection, diastolic filling time as a ratio of cycle length, and several tissue Doppler imaging techniques to assess intraventricular opposing wall delay or dispersion of time to peak velocities. Although the simple and straightforward methods are easy to reproduce, they are modest in predictive value. In contrast, tissue Doppler imaging and other more recent techniques have higher predictive value, but are technically much more complex and require training and experience. SUMMARY: This field continues to evolve and further data are needed to precisely define the appropriate role of echocardiographic dyssynchrony information in patient selection for cardiac resynchronization therapy.
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John Gorcsan (2008) conducted a review in severe symptomatic heart failure. Echocardiographic techniques was evaluated. Echocardiographic techniques like tissue Doppler imaging offer higher predictive value for cardiac resynchronization therapy response but are technically complex and require training.
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