Cardiac resynchronization therapy: Part 1--issues before device implantation.
Cardiac resynchronization therapy (CRT) has been used extensively over the last years in the therapeutic management of patients with end-stage heart failure. Data from 4,017 patients have been published in eight large, randomized trials on CRT. Improvement in clinical end points (symptoms, exercise capacity, quality of life) and echocardiographic end points (systolic function, left ventricular size, mitral regurgitation) have been reported after CRT, with a reduction in hospitalizations for decompensated heart failure and an improvement in survival. However, individual results vary, and 20% to 30% of patients do not respond to CRT. At present, the selection criteria include severe heart failure (New York Heart Association functional class III or IV), left ventricular ejection fraction <35%, and wide QRS complex (>120 ms). Assessment of inter- and particularly intraventricular dyssynchrony as provided by echocardiography (predominantly tissue Doppler imaging techniques) may allow improved identification of potential responders to CRT. In this review a summary of the clinical and echocardiographic results of the large, randomized trials is provided, followed by an extensive overview on the currently available echocardiographic techniques for assessment of LV dyssynchrony. In addition, the value of LV scar tissue and venous anatomy for the selection of potential candidates for CRT are discussed.
Bax
Jeroen J
JJ
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. jbax@knoware.nl
Abraham
Theodore
T
Barold
S Serge
SS
Breithardt
Ole A
OA
Fung
Jeffrey W H
JW
Garrigue
Stephane
S
Gorcsan
John
J
Hayes
David L
DL
Kass
David A
DA
Knuuti
Juhani
J
Leclercq
Christophe
C
Linde
Cecilia
C
Mark
Daniel B
DB
Monaghan
Mark J
MJ
Nihoyannopoulos
Petros
P
Schalij
Martin J
MJ
Stellbrink
Christophe
C
Yu
Cheuk-Man
CM
D002303:Cardiac Output, Low / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D004452:Echocardiography; D006801:Humans; D010138:Pacemaker, Artificial; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic