Assessment of apical rocking: a new, integrative approach for selection of candidates for cardiac resynchronization therapy

Szulik, Mariola; Tillekaerts, Monique; Vangeel, Vanessa; Gáname, Javier; Willems, Rik; Lenarczyk, Radosław; Rademakers, Frank; Kalarus, Zbigniew; Kukulski, Tomasz; Voigt, Jens‐Uwe

doi:10.1093/ejechocard/jeq081

Cited by 74 publications

(42 citation statements)

References 32 publications

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“…In this field echocardiography may have a role in selection of patients based in small trials [16][17][18][19]21] which have shown that different dyssynchrony indices in patients with QRSd> 120 ms can have significant predictive value for CRT response. Furthermore, in the large CARE -HF trial [7], mechanical dyssynchrony, as assessed by echocardiography, was an inclusion criterion for patients with QRSd between 120 and 150 ms.…”

Section: Discussionmentioning

confidence: 99%

“…Szulik et al [18] tested a novel echocardiographic measurement of LV dyssynchrony by analysing apical rocking. They used apical transverse motion (ATM) as a marker of apical motion perpendicular to the LV long-axis and this was calculated in each apical plane (A4C, A3C and A2C) as the average of the integrated longitudinal myocardial velocity curves from the two opposite apical segments.…”

Section: Mechanical Dyssynchrony In Patients With Significant Electrimentioning

confidence: 99%

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Echocardiographic Assessment of Cardiac Dyssynchrony. Where do We Stand?

Papachristidis

Monaghan

2014

Curr Cardiovasc Imaging Rep

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During the last two decades there has been an increasing interest in cardiac resynchronization therapy (CRT) in patients with heart failure. Major randomized clinical trials which tested the effectiveness of CRT included patients based on electrocardiographic (ECG) criteria amongst other features. However, there is an assumption that mechanical synchrony, as may be assessed by echocardiography, is the underlying mechanism that improves left ventricular function and finally the clinical outcome. Large multi-centre trials have failed to prove the usefulness of echocardiography in both selection of patients for CRT and identification of nonresponders. On the contrary smaller trials from centres where there is high expertise in echo techniques have demonstrated that mechanical dyssynchrony can be assessed by echocardiography and can actually predict the response to CRT in a better way than traditional ECG criteria. In this manuscript, we have analysed current evidence from published data and attempted to provide insight to the field of cardiac dyssynchrony as assessed with echocardiography.

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Section: Discussionmentioning

confidence: 99%

Section: Mechanical Dyssynchrony In Patients With Significant Electrimentioning

confidence: 99%

Echocardiographic Assessment of Cardiac Dyssynchrony. Where do We Stand?

Papachristidis

Monaghan

2014

Curr Cardiovasc Imaging Rep

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“…Many researchers suggested using visual markers of cardiac motion including apical rocking and septal flash as indicators for dyssynchrony [18, 19]. However, dyssynchrony is often subtle, and so it cannot be quantified by visual assessment alone.…”

Section: Patterns Of Motion and Deformationmentioning

confidence: 99%

“…However, dyssynchrony is often subtle, and so it cannot be quantified by visual assessment alone. Quantitative tools should be used to complement the visual description of myocardial deformation [18-20]. …”

Section: Patterns Of Motion and Deformationmentioning

confidence: 99%

Cardiac Resynchronization Therapy Optimization: A Comprehensive Approach

et al. 2019

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Since the first report on biventricular pacing in 1994, cardiac resynchronization therapy (CRT) has become standard for patients with advanced heart failure (HF) and ventricular conduction delay. CRT improves myocardial function by resynchronizing myocardial contraction, which results in reverse left ventricular remodeling and improves symptoms and clinical outcomes. Despite the accelerated development of CRT device technology and its increased application in treating HF patients, almost one-third of these patients do not respond to the therapy or gain any clinical benefit from device implantation. Over the last decade, multiple cardiac imaging modalities have provided a deeper understanding of myocardial pathophysiology, thereby improving HF treatment management. However, the optimal strategy for improving the CRT response remains debatable. This article provides an updated overview of the electropathophysiology of myocardial dysfunction in ventricular conduction delay and the diagnostic approaches involving the use of multiple modalities.

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“…Although RSDc or radial discoordination index method seems more logical and more practical than time-based dyssynchrony, they need to be validated by multicenter trials and compared with other possible parameters such as apical rocking motion, which can be quickly assessed visually. 17 It will take some time for the CRT community to have confidence in an echocardiographic parameter to be used for the selection of patients for CRT. We now have learned that any future echocardiography parameter for prediction of CRT response should use the concept of wasted energy and not rely on temporal dyssynchrony alone, as Kydd et al 10 demonstrated.…”

mentioning

confidence: 99%