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Controversies in Imaging

Is echocardiographic assessment of dyssynchrony useful to select candidates for cardiac resynchronization therapy?

Echocardiography Is Not Useful Before Cardiac Resynchronization Therapy if QRS Duration Is Available

Frits W. Prinzen, PhD and Angelo Auricchio, MD, PhD

From the Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands (F.W.P.); and Cardiocentro Ticino, Lugano, Switzerland (A.A.).

Correspondence to Frits W. Prinzen, PhD, Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. E-mail Frits.Prinzen@FYS.unimaas.nl

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

	Introduction

 
Several multicenter prospective randomized trials have shown that cardiac resynchronization therapy (CRT) improves functional capacity and quality of life in 70% of symptomatic heart failure (HF) patients.¹ A smaller proportion of these selected patients shows a >5% increase in left ventricular (LV) ejection fraction and a >15% reduction of LV end-systolic volume, indicating reverse remodeling of the LV.² Finally, CRT reduces morbidity and mortality rates by 30% to 40%.³ These data are comparable to those of established pharmacological therapies for HF, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and aldosterone antagonists. Of note, CRT is indicated in HF patients who remained symptomatic despite medical therapy; thus, they could be considered nonresponders to medical therapy. However, the precise proportion of nonresponders to medical therapy has not yet been quantified.

Response by Abraham and Abraham see p 70

Notwithstanding CRT being a very efficacious and cost-effective treatment, several efforts have been made to reduce the number of nonresponder patients. The issue of patients not responding to CRT is rather complex. There is lack of agreement on the definition of nonresponder (volumetric, functional, or exercise response), the cause of CRT nonresponse is likely multifactorial, and some patients may be too sick to show a meaningful and measurable benefit ("beyond repair"). Currently, we do not know which factors are predicting response to therapy and the relative weight of each of these factors. Therefore, the proportion of patients who are not amenable to CRT remains undefined. Among the factors predicting response to CRT, the . . . [Full Text of this Article]

Related Article

Is echocardiographic assessment of dyssynchrony useful to select candidates for cardiac resynchronization therapy?: Echocardiography Is Not Useful Before Cardiac Resynchronization Therapy if QRS Duration Is Available

Frits W. Prinzen and Angelo Auricchio
Circ Cardiovasc Imaging 2008 1: 70-78. [Extract] [Full Text] [PDF]