Usefulness of Left Ventricular Systolic Dyssynchrony by Real-Time Three-Dimensional Echocardiography to Predict Long-Term Response to Cardiac Resynchronization Therapy

Soliman, Osama Ibrahim Ibrahim; Geleijnse, Marcel L.; Theuns, Dominic; Dalen, Bas M. van; Vletter, Wim B.; Jordaens, Luc; Metawei, Ahmed K.; Al-Amin, Aly M; Cate, Folkert J. ten

doi:10.1016/j.amjcard.2009.01.372

Cited by 66 publications

(58 citation statements)

References 27 publications

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“…The same group confirmed these findings in a similar cohort of 90 patients undergoing CRT [27]. After 12 months of CRT, 68 patients (76%) were responders.…”

Section: Sdi As a Predictor Of Outcome Of Cardiac Resynchronization Tsupporting

confidence: 85%

Cardiac dyssynchrony

Monaghan¹,

Adhya²

2015

Three-Dimensional Echocardiography

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“…The same group confirmed these findings in a similar cohort of 90 patients undergoing CRT [27]. After 12 months of CRT, 68 patients (76%) were responders.…”

Section: Sdi As a Predictor Of Outcome Of Cardiac Resynchronization Tsupporting

confidence: 85%

Cardiac dyssynchrony

Monaghan¹,

Adhya²

2015

Three-Dimensional Echocardiography

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“…63 Benefits from CRT have been defined as a ≥15% reduction in LV end-systolic volume at follow-up, 60,62,63 which can also readily be measured using 3D echocardiography. Finally, the importance of optimal LV pacing lead position was emphasized in a 3DE study in which the responses to CRT were compared between patients with the LV pacing lead positioned at the site of maximal mechanical delay and those in whom the pacing lead was positioned distal to that site.…”

Section: Dyssynchronymentioning

confidence: 99%

EAE/ASE Recommendations for Image Acquisition and Display Using Three-Dimensional Echocardiography

Lang

Badano

Tsang

et al. 2012

Journal of the American Society of Echocardiography

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858

513

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“…However, more recent studies evaluating speckle tracking and 3-dimensional imaging show findings similar to those of previous dyssynchrony parameters. 24,26,27 The decision to offer CRT to an individual patient is based on a number of factors, many of which are included in the current guidelines. However, given the high cost and the risk associated with this invasive therapy, we agree that further research is needed to tailor this therapy to patients who derive benefit while minimizing the use of this therapy in patients who do not.…”

Section: Discussionmentioning

confidence: 99%

“…For example, the recommended thresholds for dyssynchrony with the use of the same parameter differ among investigators. For speckle tracking, the optimal cutoff value for the standard deviation in time to peak radial strain ranges from 55.3 to 76 ms, 24,25 and in real-time 3-dimensional echocardiography, the optimal cutoff value for a 16-segment systolic dyssynchrony index ranges from 6.4% to Ͼ10%. 26,27 Finally, well-established echocardiography sites with strong research backgrounds have rarely been able to reproduce published findings and often have found frankly contradictory results.…”

Section: Echocardiographic Dyssynchrony Parametersmentioning

confidence: 99%

Assessment of Systolic Dyssynchrony for Cardiac Resynchronization Therapy Is Not Clinically Useful

Sung

Foster

2011

Circulation

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C ardiac resynchronization therapy (CRT) is an effective treatment in patients with medically refractory heart failure. Several clinical trials have shown improvement in both left ventricular (LV) function and symptoms with CRT compared with controls, 1-4 with the 2 largest trials showing a reduction in rates of hospitalization and death. 5,6 On the basis of data from these studies, most international guidelines agree on the standard indications for CRT: impaired functional status with New York Heart Association functional class III or IV, LV ejection fraction (LVEF) Յ35%, and prolonged QRS duration Ն120 ms in the setting of optimal medical therapy. 7-9 However, not all patients experienced improvement in symptoms or LV function, and numerous studies have focused on improving the selection criteria for CRT in the hopes of excluding these "nonresponders." [1][2][3][4] One of the most frequently studied modalities for patient selection is echocardiographic measurement of LV systolic dyssynchrony based on the supposition that there is a threshold for mechanical dyssynchrony below which there is no therapeutic benefit. Despite these studies, we argue that current echocardiographic methods of measuring dyssynchrony should not be used to exclude patients who are otherwise candidates for CRT. Conversely, in patients with narrow QRS, echocardiographic evidence of dyssynchrony is insufficient to warrant CRT on the basis of current data. Response by Delgado and Bax on p 663There are important unresolved issues regarding the use of mechanical dyssynchrony measurements for determining CRT eligibility in an individual patient. Let us examine the case of a 60-year-old man with ischemic cardiomyopathy, recurrent hospitalizations, and New York Heart Association functional class III despite an excellent heart failure drug regimen. He inquires about additional therapy to help improve his symptoms and keep him out of the hospital. His LVEF is 30% by echocardiogram, and the ECG shows a QRS duration of 150 ms in a left bundle-branch block configuration. Current guidelines clearly state that this patient qualifies for CRT. However, proponents of mechanical dyssynchrony would require additional evaluation before referring him for CRT. If evaluation for mechanical dyssynchrony is undertaken, many issues are unresolved, including the value of measuring intraventricular and/or interventricular dyssynchrony, the best modality to use for intraventricular dyssynchrony, and the threshold values that define the presence of mechanical dyssynchrony. Most importantly, if mechanical dyssynchrony is not demonstrated, is the weight of this evidence sufficient to advise against CRT implantation in the patient, contrary to guidelines?After reviewing the available data, we will present the case that current measures of mechanical dyssynchrony do not add clinical utility in selecting patients for CRT beyond current guidelines. Key issues to be addressed include the following: (1) defining "response" to CRT; (2) the clinical relevance of employing echo...

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Usefulness of Left Ventricular Systolic Dyssynchrony by Real-Time Three-Dimensional Echocardiography to Predict Long-Term Response to Cardiac Resynchronization Therapy

Cited by 66 publications

References 27 publications

Cardiac dyssynchrony

Cardiac dyssynchrony

EAE/ASE Recommendations for Image Acquisition and Display Using Three-Dimensional Echocardiography

Assessment of Systolic Dyssynchrony for Cardiac Resynchronization Therapy Is Not Clinically Useful

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