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Editorials

In Search of a Holy Grail

Predicting Cardiac Resynchronization Therapy Outcomes by Echocardiography

Zoran B. Popovi, MD and James D. Thomas, MD

From The Cleveland Clinic Foundation, Cleveland, Ohio.

Correspondence to James D. Thomas, MD, FAHA, Department of Cardiology, Desk F-15, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. E-mail thomasj@ccf.org

Key Words: Editorials • echocardiography • cardiac resynchronization therapy • heart failure • pacing • pacemakers

An extract of the first 250 words of the full text is provided, because this article has no abstract.

"It came out of nowhere and captured the cardiology community by storm." The cliché seems very appropriate when describing the impact of cardiac resynchronization therapy (CRT) on the treatment of heart failure. CRT improves survival rate in symptomatic patients ¹ and is the only nonsurgical technique that provides substantial and stable reverse remodeling in both symptomatic and asymptomatic patients.^2,3 The most surprising fact is that this is accomplished through mechanisms that are still unclear and that are not fully elucidated in experimental models. CRT is the only heart failure therapy with a potential to improve survival rate that is not based on neurohormonal modulation. Finally, it represents a challenge to the imaging community, as it establishes a need to measure something that was previously overlooked—dyssynchrony.

Article see p 14

Unfortunately, CRT is not universally successful. One third of CRT patients do not feel better,⁴ and close to 40% of patients do not experience reverse remodeling, which is important because it predicts survival rate.⁵ This should not be a surprise—treatment of chronic diseases is rarely homogenously beneficial to all the patients. Nevertheless, in the case of CRT, some extra precautions are necessary. CRT is expensive; placement of electrodes may be difficult; and, even in experienced centers, a significant number of patients may require surgical placement. Finally, it is an expensive, healthcare-intensive therapy with extensive follow-up and occasional complications. Thus, there is an ongoing search for practical methods to predict the outcome of CRT and guide its use. Current guidelines use QRS duration . . . [Full Text of this Article]

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