Echocardiography for the management of patients with biventricular pacing: Possible roles in cardiac
Emmanouil Poulidakis1, Constantina Aggeli2, Konstantinos Kappos1
1Department of Cardiology, Evagelismos General Hospital of Athens, 45 Ipsilandou st., 10676, Athens, Greece.
Insights
Cardiac resynchronization therapy (CRT) helps heart failure patients, but many don't respond. Echocardiography shows promise for identifying responders and optimizing CRT.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Cardiac resynchronization therapy (CRT) is a standard treatment for heart failure (HF) patients with reduced ejection fraction (EF) and electrocardiographic (ECG) dyssynchrony.
- Despite proven benefits in trials, a significant number of patients with wide QRS complexes do not respond to CRT.
Purpose of the Study:
- To explore the utility of echocardiographic indices in identifying CRT responders.
- To evaluate the role of echocardiography in optimizing CRT implementation.
Main Methods:
- Review of existing clinical trials and research on CRT response prediction.
- Analysis of various echocardiographic parameters assessing mechanical dyssynchrony.
- Discussion of echocardiography's role in left ventricular (LV) lead placement and pacing optimization.
Main Results:
- Current echocardiographic methods lack the sensitivity and specificity for reliable prediction of CRT response.
- No single echocardiographic measurement has been identified as a definitive predictor of CRT benefit.
- Echocardiography is valuable for LV lead site selection and optimizing pacing parameters post-implantation.
Conclusions:
- Predicting CRT response remains a challenge, necessitating further research into novel diagnostic tools.
- Echocardiography plays a crucial, albeit indirect, role in enhancing CRT efficacy through procedural guidance and optimization.
Abstract:
Cardiac resynchronization therapy (CRT) is an established therapeutic option for the subset of patients with heart failure (HF), reduced ejection fraction (EF), and dyssynchrony evidenced by electrocardiography. Benefit from CRT has been proven in many clinical trials, yet a sizeable proportion of these patients with wide QRS do not respond to this intervention, despite the updated practice guidelines. Several echocardiographic indices, targeting mechanical rather than electrical dyssynchrony, have been suggested to address this issue, but research so far has not succeeded in providing a single and simple measurement with adequate sensitivity and specificity for identification of responders. While there is still ongoing research in this field, echocardiography proves helpful in other aspects of CRT implementation, such as site selection for left ventricular (LV) lead pacing and optimization of pacing parameters during follow-up visits.
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