Patient assessment for cardiac resynchronization therapy: Past, present and future of imaging techniques

Area of Science:

• Cardiology
• Medical Imaging
• Biomedical Engineering

Background:

• Up to 40% of patients do not respond to cardiac resynchronization therapy (CRT).
• Accurate patient selection for CRT remains a significant clinical challenge.
• Echocardiographic dyssynchrony assessment was proposed to predict CRT response.

Purpose of the Study:

• To review current evidence on patient selection for CRT.
• To evaluate the utility of dyssynchrony parameters in predicting CRT response.
• To propose a stepwise approach integrating imaging and clinical data for patient selection.

Main Methods:

• Review of existing literature and recent data on CRT response predictors.
• Analysis of findings from the Predictors of Response to Cardiac Resynchronization Therapy (PROSPECT) trial.
• Integration of novel imaging techniques with current evidence.

Main Results:

• The PROSPECT trial did not identify a single ideal echocardiographic parameter for dyssynchrony.
• Current dyssynchrony criteria alone are insufficient for predicting CRT response.
• A multimodal approach is essential for optimal patient selection.

Conclusions:

• Patient selection for CRT requires a comprehensive strategy beyond simple dyssynchrony assessment.
• New imaging tools and a stepwise approach are promising for improving CRT response prediction.
• Further research is needed to refine patient selection algorithms for CRT.