Echocardiography for cardiac resynchronization therapy: recommendations for performance and reporting--a report from the American Society of Echocardiography Dyssynchrony Writing Group endorsed by the Heart Rhythm Society.
Echocardiography plays an evolving and important role in the care of heart failure patients treated with biventricular pacing, or cardiac resynchronization therapy (CRT). Numerous recent published reports have utilized echocardiographic techniques to potentially aide in patient selection for CRT prior to implantation and to optimized device settings afterwards. However, no ideal approach has yet been found. This consensus report evaluates the contemporary applications of echocardiography for CRT including relative strengths and technical limitations of several techniques and proposes guidelines regarding current and possible future clinical applications. Principal methods advised to qualify abnormalities in regional ventricular activation, known as dyssynchrony, include longitudinal velocities by color-coded tissue Doppler and the difference in left ventricular to right ventricular ejection using routine pulsed Doppler, or interventricular mechanical delay. Supplemental measures of radial dynamics which may be of additive value include septal-to-posterior wall delay using M-mode in patients with non-ischemic disease with technically high quality data, or using speckle tracking radial strain. A simplified post-CRT screening for atrioventricular optimization using Doppler mitral inflow velocities is also proposed. Since this is rapidly changing field with new information being added frequently, future modification and refinements in approach are anticipated to continue.
Gorcsan
John
J
University of Pittsburgh, Pittsburgh, Pennsylvania 15213-2582, USA. gorcsanj@upmc.edu
Abraham
Theodore
T
Agler
Deborah A
DA
Bax
Jeroen J
JJ
Derumeaux
Genevieve
G
Grimm
Richard A
RA
Martin
Randy
R
Steinberg
Jonathan S
JS
Sutton
Martin St John
MS
Yu
Cheuk-Man
CM
D002304:Cardiac Pacing, Artificial / Q000592:standards*; D004452:Echocardiography / Q000592:standards*; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000592:standards; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011379:Prognosis; D014481:United States; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000517:prevention & control*