[Cardiac resynchronization therapy: preoperative screening. How can we reliably predict response to CRT?].

Area of Science:

• Cardiology
• Medical Imaging
• Heart Failure Management

Background:

• Cardiac resynchronization therapy (CRT) is a standard treatment for specific heart failure patients.
• A significant percentage of patients (30-45%) exhibit non-response to CRT.
• Echocardiographic parameters for dyssynchrony have been developed to predict CRT response.

Purpose of the Study:

• To critically review echocardiographic techniques for assessing cardiac dyssynchrony.
• To explore the various causes and mechanisms of non-response to CRT.
• To propose a rational basis for patient evaluation for CRT based on current evidence and guidelines.

Main Methods:

• Literature review of randomized multicenter studies on CRT response prediction.
• Analysis of echocardiographic dyssynchrony parameters and their clinical utility.
• Evaluation of national and international guideline recommendations for CRT.

Main Results:

• The utility of current echocardiographic dyssynchrony indexes in predicting CRT response is debated.
• Multiple factors contribute to non-response to CRT beyond simple dyssynchrony.
• A critical overview of available echocardiographic techniques is presented.

Conclusions:

• Current echocardiographic methods for predicting CRT response require critical evaluation.
• Understanding the diverse causes of non-response is crucial for optimizing CRT outcomes.
• A structured approach to patient selection for CRT is proposed to improve therapeutic success.