Mechanical dyssynchrony in heart failure: Still a valid concept for optimizing treatment?

Area of Science:

• Cardiology
• Medical Imaging
• Heart Failure Management

Background:

• Cardiac resynchronization therapy (CRT) significantly benefits patients with symptomatic heart failure, reduced ejection fraction, and wide QRS complexes.
• A substantial proportion of patients (around 35%) do not respond to CRT, highlighting the need for improved patient selection to maximize benefits and reduce healthcare costs.

Purpose of the Study:

• To provide an overview of recent advancements in imaging-guided CRT.
• To discuss the evolving role of myocardial imaging in assessing CRT candidates, guiding lead implantation, and optimizing CRT delivery.

Main Methods:

• Review of recent literature on imaging techniques for CRT.
• Analysis of the utility of echocardiography and fusion imaging in predicting CRT response.
• Discussion of imaging's role in procedural guidance and therapy optimization.

Main Results:

• Previous studies suggested echocardiography could predict CRT response, but large trials like Prospect and EchoCRT did not confirm this.
• Recent improvements in myocardial imaging and fusion imaging offer new potential for understanding dyssynchrony and guiding CRT.
• Imaging may play a crucial role in future CRT strategies for patient selection and procedural success.

Conclusions:

• Despite past challenges, advanced imaging techniques show promise for improving patient selection and procedural guidance in CRT.
• Fusion imaging offers potential for a deeper understanding of dyssynchrony and precise lead placement.
• Further research and validation are needed to fully integrate imaging into routine CRT practice and overcome current limitations.