January 10, 2026European Heart Journal - Imaging Methods and Practice0 citationsOpen Access
How to visually diagnose mechanical dyssynchrony in cardiac resynchronization therapy candidates using echocardiography
Key Result
Visual assessment of mechanical dyssynchrony using SFoAR patterns may improve patient selection for CRT, enhancing response rates in heart failure patients.
Key Points
- To provide a practical workflow for visually diagnosing mechanical dyssynchrony in patients considered for cardiac resynchronization therapy (CRT).
- Developed a four-step workflow for visual assessment of mechanical dyssynchrony using echocardiography.
- Included high-quality, multi-view echocardiographic acquisition as the first step.
- Identified septal flash and apical rocking as indicators of mechanical dyssynchrony.
- Confirmed mechanical dyssynchrony by the presence of either motion pattern.
- Mechanical dyssynchrony is strongly associated with benefit from CRT, affecting response rates.
- Visual assessment of mechanical dyssynchrony may improve patient selection for CRT.
- Ongoing AMEND-CRT trial is evaluating the effectiveness of this visual assessment compared to guidelines.
Structured PICO
P
Population
Patients with heart failure and broad QRS complex who are candidates for cardiac resynchronization therapy
I
Intervention
Visual assessment of mechanical dyssynchrony (MechDys) by septal flash and/or apical rocking (SFoAR) using echocardiography
A practical four-step workflow for the visual assessment of mechanical dyssynchrony using echocardiography may improve patient selection for cardiac resynchronization therapy.
Main Result
Absolute Event Rate: 0% vs 0%
Abstract
Abstract Cardiac resynchronization therapy (CRT) improves outcomes in patients with heart failure and broad QRS complex, yet 20–45% do not respond. Mechanical dyssynchrony (MechDys)—identified visually by septal flash and/or apical rocking (SFoAR)—is strongly associated with CRT benefit. This ‘How to’ paper outlines a practical four-step workflow for the visual assessment of MechDys. First, a high-quality, multi-view echocardiographic acquisition is essential. Second, septal flash4 (SF) is recognized as an early leftward septal motion, often with rebound, preceding lateral wall contraction; its magnitude depends on conduction delay, myocardial contractility, and right heart loading. Third, ApR is identified as a biphasic apical motion reflecting sequential septal and lateral wall contractions; its appearance may be modified by scarring, pacing, or imaging artefacts. MechDys is confirmed when either motion pattern is present. Clinically, the visual assessment of MechDys may improve patient selection for CRT, thus improving response rates. The ongoing AMEND-CRT trial is evaluating whether incorporating SFoAR assessment is non-inferior to guideline recommendations. Pending prospective evidence, existing observational data supports the use of visual assessment of MechDys to guide decision-making in patients with intermediate CRT indications.
Cite This Study
Diogo et al. (Fri,) reported a other. Visual assessment of mechanical dyssynchrony using SFoAR patterns may improve patient selection for CRT, enhancing response rates in heart failure patients.