title: Tissue Doppler echocardiography and biventricular pacing in heart failure: patient selection, procedural guidance, follow-up, quantification of success.
abstract: Asynchronous myocardial contraction in heart failure is associated with poor prognosis. Resynchronization can be achieved by biventricular pacing (BVP), which leads to clinical improvement and reverse remodeling. However, there is a substantial subset of patients with wide QRS complexes in the electrocardiogram that does not improve despite BVP. QRS width does not predict benefit of BVP and only correlates weakly with echocardiographically determined myocardial asynchrony. Determination of asynchrony by Tissue Doppler echocardiography seems to be the best predictor for improvement after BVP, although no consensus on the optimal method to assess asynchrony has been achieved yet. Our own preliminary results show the usefulness of Tissue Doppler Imaging and Tissue Synchronization Imaging to document acute and sustained improvement after BVP. To date, all studies evaluating Tissue Doppler in BVP were performed retrospectively and no prospective studies with patient selection for BVP according to echocardiographic criteria of asynchrony were published yet. We believe that these new echocardiographic tools will help to prospectively select patients for BVP, help to guide implantation and to optimize device programming.
authors.affiliation: Charité Campus Mitte - University Medicine Berlin, Medical Clinic for Cardiology, Angiology, Pneumology, 10098 Berlin, Germany. fabian.knebel@charite.de
authors.forename: Fabian
authors.initials: F
authors.lastname: Knebel
authors.forename: Rona Katharina
authors.initials: RK
authors.lastname: Reibis
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Bondke
authors.forename: Joachim
authors.initials: J
authors.lastname: Witte
authors.forename: Torsten
authors.initials: T
authors.lastname: Walde
authors.forename: Stephan
authors.initials: S
authors.lastname: Eddicks
authors.forename: Gert
authors.initials: G
authors.lastname: Baumann
authors.forename: Adrian Constantin
authors.initials: AC
authors.lastname: Borges
mesh_terms: D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002986:Clinical Trials as Topic; D015150:Echocardiography, Doppler / Q000379:methods*; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control*