iventricular pacing (BVP) is currently indicated for the treatment of patients with medically refractory heart failure and electrical dyssynchrony, 1-4 but it is becoming increasingly clear that QRS duration is an inadequate predictor of the response to BVP therapy. [4][5][6] Because the improvement in mechanical dyssynchrony after BVP correlates with improvement in clinical status and reverse remodeling, [6][7][8][9][10][11][12] there are ongoing investigations to determine the most accurate and efficient method of detecting mechanical dyssynchrony. Echocardiography, including tissue Doppler imaging (TDI), is simple, easy and ideal for evaluating regional wall motion. [5][6][7][8][9][10][11][12][13] Furthermore, recent advances in TDI and strain Doppler imaging (SDI) have enhanced the ability to evaluate ventricular synchrony and regional myocardial function. [5][6][7][8][9][10][11][12][13][14][15][16] However, the utility and efficacy of TDI and SDI for evaluating ventricular synchrony and function and for predicting long-term clinical improvement in patients undergoing BVP have not been sufficiently determined. The purpose of this study was to clarify this point. Methods Study PopulationThis study included 17 patients with advanced heart failure and a wide QRS complex who received a pacemaker or an implantable cardioverter defibrillator (ICD) providing BVP. There were 12 men and 5 women, and their mean age was 66±9 years; 13 patients had idiopathic cardiomyopathy, 2 had ischemic heart disease, and the remaining 2 had valvular heart disease; 11 patients were in New York Heart Association (NYHA) functional class IV, and the remaining 6 were in class III despite maximal pharmacologic therapy at the time of pacemaker implantation. The QRS interval was >140 ms and the left ventricular (LV) ejection fraction determined by echocardiography was <40% in all the patients.Patients were divided into 2 groups according to their clinical status at the end of the follow-up period (23±7 months; range: 14-37 months): the responder group (n=12) and the nonresponder group (n=5; Table 1). The clinical status of each patient was determined at the end of the follow-up period by 2 cardiologists who did not have any information concerning the BVP status of the patients. A responder was defined as a patient who improved clinically to NYHA functional class I or II during the follow-up period and a nonresponder was one who did not. There was no significant difference between the 2 groups in the NYHA classification before the initiation of BVP (p=0.9; Background The purpose of this study was to determine the utility and efficacy of tissue Doppler imaging (TDI) and strain Doppler imaging (SDI) for evaluating ventricular synchrony and function, and for predicting the long-term clinical improvement in patients undergoing biventricular pacing (BVP). Methods and Results TDI and SDI were performed before and <1 month after initiating BVP in 17 patients with advanced heart failure. An intraventricular conduction delay between the left ventricu...

Echocardiography plays a pivotal role as an imaging modality in the modern cardiology practice. Information derived from echocardiography is definitely helpful for a patient care. The Japanese Society of Echocardiography has promoted echocardiography for a routine clinical and research use. One of the missions of the Society is to provide information that is useful for high-quality examinations. To ensure it, we believe equipment in good conditions and a comfortable environment are important for both a patient and an examiner. Thus, the Committee for Guideline Writing, the Japanese Society of Echocardiography published brief guidance for the routine use of echocardiography equipment in 2015. Recently, the importance of international standardization has been emphasized in the medical laboratories. Accordingly, the committee has revised and updated our guidance for the routine use of echocardiography equipment.

Echocardiography plays a pivotal role as an imaging modality in modern cardiology practice. Information derived from echocardiography is definitely helpful for patient care. The Japanese Society of Echocardiography has promoted echocardiography in routine clinical and research use. One of the missions of the Society is to provide information that is useful for high-quality examinations. To ensure this, we believe that equipment in good condition and a comfortable environment are important for both patient and examiner. Here, the Guideline Preparation Committee of the Japanese Society of Echocardiography has established brief guidance for the routine use of echocardiography equipment.

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ardiac resynchronization therapy (CRT) in patients with advanced heart failure (HF) and a ventricular conduction delay improves symptoms and functional capacity, induces reverse remodeling, and reduces morbidity, and probably mortality. [1][2][3][4] It is well known that although the vast majority of CRT recipients present with left bundle branch block (LBBB), up to 10% of the minority have nonspecific conduction delays or right bundle branch block (RBBB). 2,5 Recently, RBBB was proven to be an important predictor of mortality in patients with congestive HF, just as has LBBB. 6 However, patients with RBBB and congestive HF have not been adequately evaluated because of an under-representation in the referenced studies. Therefore, which type of patients with RBBB has ventricular conduction delays, and thus are good candidates for CRT, has not been fully clarified. Methods Study PopulationThis study included 104 patients (34 women, 70 men; mean age, 59±15 years) who underwent conventional echocardiography, including tissue Doppler imaging (TDI) and tissue tracking imaging (TTI) between January 2002 and December 2004. Of these, 49 consecutive patients had complete RBBB (CRBBB) with a duration of the QRS complex of ≥120 ms (RBBB-Gr). The remaining 55 had normal morphology of the QRS complex and narrow QRS (<120 ms; Control-Gr), and were randomly selected so that the data collected would be statistically matched to the RBBB-Gr patients in terms of age and gender (Table 1). In total, 33 patients had hypertension, 5 dilated cardiomyopathy, 5 mitral valvular diseases, 2 hypertrophic cardiomyopathy, 1 congenital heart disease, 3 ischemic heart disease, and the remaining 93 (89%) had no structural heart disease. Echocardiography demonstrated that the mean left ventricular ejection fraction (LVEF) was 64.2±11.8% (range, 12-83), and left ventricular end-diastolic diameter (LVEDD) 46.5± 8.5 mm (range, 34-75). All patients were in sinus rhythm, and the mean QRS duration was 113.8±33.3 ms (range, 70-200). All patients in the Control-Gr had LVEF >50% (range, 51-83). Echocardiographic Examination Including TDI and TTIThe left ventricular (LV) dimensions were measured by M-mode echocardiography in the parasternal long-axis view. The LVEDD was measured at the onset of the QRS Background The indications and efficacy of cardiac resynchronization therapy (CRT) have not been sufficiently clarified in patients with right bundle branch block (RBBB). Methods and ResultsThis study included 55 patients with normal QRS morphology and duration (ControlGr) and 49 patients with complete RBBB (CRBBB-Gr). Using tissue Doppler imaging, the time difference (TD) between the electromechanical delay of the septal wall, left ventricular (LV) lateral wall, and right ventricular free wall were measured. Using tissue tracking imaging, the coefficient of the time variation from the beginning of the QRS to the peak displacement time of 6 regions of the LV (CV-PMDLV) was calculated. The TD between the septal wall and that of the LV lateral wall (TDSEPT-LAT)...