Key result
Stress echocardiography may improve CRT response prediction by assessing contractile reserve and dyssynchrony.
Why the study?
About 30% of patients selected for CRT based on QRS duration do not respond, and resting Doppler echocardiography criteria have not been routinely recommended for patient selection.
Does stress echocardiography improve the prediction of response to cardiac resynchronisation therapy in potential CRT candidates?
Does stress echocardiography improve the prediction of response to cardiac resynchronisation therapy in potential CRT candidates?
Stress echocardiography may offer additional value over resting echocardiography and QRS duration in identifying patients likely to respond to cardiac resynchronisation therapy.
Stress echocardiography may refine CRT responder selection; hypothesis-generating and should not yet change practice.
In the current ESC/ACC/AHA guidelines, the selection of patients for cardiac resynchronisation therapy (CRT) is based upon the QRS duration, which reflects interventricular dyssynchrony. However, about 30% of patients do not respond to CRT. It has previously been demonstrated that the presence of left ventricular mechanical dyssynchrony is predictive of response to CRT after implantation. Most criteria assessing such dyssynchrony were derived from data obtained with resting Doppler echocardiography. The recently published PROSPECT (Predictors of Response to CRT) trial failed to identify echocardiographic measures of dyssynchrony that could routinely be recommended for patient selection before CRT implantation. Therefore, solutions may come from other echocardiographic modalities, such as dobutamine stress echocardiography and exercise echocardiography. The purpose of this review is to evaluate the usefulness of stress echocardiography to predict response to CRT. This review will show how exercise-induced changes in dyssynchrony and severity of mitral regurgitation and the role of preserved contractile reserve may help to better identify potential responders.
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Moonen et al. (2010) conducted a review in Candidates for cardiac resynchronisation therapy (CRT). Stress echocardiography was evaluated on Response to cardiac resynchronisation therapy. Stress echocardiography, including dobutamine and exercise modalities, may help better identify potential responders to cardiac resynchronisation therapy by assessing contractile reserve and dyssynchrony.
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