Key result
Echo assessment of mechanical dyssynchrony shows no benefit over standard QRS criteria for CRT selection.
Why the study?
Approximately 30% of patients meeting current CRT criteria do not respond, raising uncertainty about the necessity of mechanical dyssynchrony assessment for CRT indication.
Does assessment of mechanical dyssynchrony improve patient selection for cardiac resynchronization therapy beyond current guidelines in patients with heart failure?
Does assessment of mechanical dyssynchrony improve patient selection for cardiac resynchronization therapy beyond current guidelines in patients with heart failure?
Routine echocardiographic assessment of mechanical dyssynchrony is not currently recommended for determining CRT indication; standard QRS width criteria should remain the primary selection method.
Echocardiographic dyssynchrony assessment may be omitted for CRT decisions beyond QRS criteria; leaves open prospective validation in targeted populations.
Contraction delay of the lateral left ventricular free wall can be improved by biventricular pacing. Cardiac resynchronization therapy (CRT) is based on the principle of resynchronizing un-uniformed contraction of the ventricle. Prolongation of the QRS duration on an electrocardiogram served as an indirect marker to identify mechanical dyssynchrony. One of the greatest problems is approximately 30% of the patients who met the criteria do not respond for CRT. One possible explanation for the lack of response for CRT could be the absence of sufficient dyssynchrony to allow the therapy to have any impact. Direct assessments of mechanical dyssynchrony might better select responder patients for CRT. However, RethinQ study demonstrated that patients with heart failure and narrow QRS intervals might not benefit from CRT, even with dyssynchrony. Moreover, the results of the PROSPECT study suggest given the modest sensitivity and specificity in the multicenter setting, despite training and central analysis, no single echocardiographic measurement of dyssynchrony could be recommended to improve patient selection for CRT beyond current guidelines. At present, assessment of mechanical dyssynchrony is not necessary in determining CRT indication. Current indication including QRS width is recommended as selection criteria to identify patients suitable for CRT.
No takes yet. Share an insight, caveat, or question.
Toshiyuki Ishikawa (2011) conducted a review in Heart failure. Echocardiographic assessment of mechanical dyssynchrony vs. Standard QRS duration criteria was evaluated. Current evidence suggests that echocardiographic assessment of mechanical dyssynchrony is not necessary for determining cardiac resynchronization therapy indication beyond standard QRS width criteria.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: