Tissue Doppler echocardiography and biventricular pacing in heart failure: patient selection, procedural guidance, follow-up, quantification of success.
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.
Knebel
Fabian
F
Charité Campus Mitte - University Medicine Berlin, Medical Clinic for Cardiology, Angiology, Pneumology, 10098 Berlin, Germany. fabian.knebel@charite.de
Reibis
Rona Katharina
RK
Bondke
Hans-Jürgen
HJ
Witte
Joachim
J
Walde
Torsten
T
Eddicks
Stephan
S
Baumann
Gert
G
Borges
Adrian Constantin
AC
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*