title: Echocardiography and cardiac resynchronisation therapy, friends or foes?
abstract: Echocardiography is used in cardiac resynchronisation therapy (CRT) to assess cardiac function, and in particular left ventricular (LV) volumetric status, and prediction of response. Despite its widespread applicability, LV volumes determined by echocardiography have inherent measurement errors, interobserver and intraobserver variability, and discrepancies with the gold standard magnetic resonance imaging. Echocardiographic predictors of CRT response are based on mechanical dyssynchrony. However, parameters are mainly tested in single-centre studies or lack feasibility. Speckle tracking echocardiography can guide LV lead placement, improving volumetric response and clinical outcome by guiding lead positioning towards the latest contracting segment. Results on optimisation of CRT device settings using echocardiographic indices have so far been rather disappointing, as results suffer from noise. Defining response by echocardiography seems valid, although re-assessment after 6 months is advisable, as patients can show both continuous improvement as well as deterioration after the initial response. Three-dimensional echocardiography is interesting for future implications, as it can determine volume, dyssynchrony and viability in a single recording, although image quality needs to be adequate. Deformation patterns from the septum and the derived parameters are promising, although validation in a multicentre trial is required. We conclude that echocardiography has a pivotal role in CRT, although clinicians should know its shortcomings.
authors.affiliation: Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA, Utrecht, The Netherlands. w.m.vaneverdingen@umcutrecht.nl.
authors.forename: W M
authors.initials: WM
authors.lastname: van Everdingen
authors.affiliation: Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: J C
authors.initials: JC
authors.lastname: Schipper
authors.affiliation: Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: van 't Sant
authors.affiliation: Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Ramdat Misier
authors.affiliation: Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Meine
authors.affiliation: Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Cramer
keywords: 3D echocardiography; Cardiac resynchronisation therapy; Deformation imaging; Dyssynchrony; Echocardiography; Follow-up; Interobserver variability; Optimisation; Response; Septal strain; Speckle tracking echocardiography; Volume