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Refining cardiac resynchronization therapy: a comprehensive review on the role of advanced multimodality imaging
Flavia-Mihaela Stoiculescu1,2, Diana-Ruxandra Hădăreanu2,3, Călin-Dinu Hădăreanu1,4
1Doctoral School, University of Medicine and Pharmacy of Craiova, Craiova, Romania.
Insights
Identifying the best cardiac imaging techniques is crucial for selecting patients who will benefit from cardiac resynchronization therapy (CRT) for heart failure (HF). This review highlights advanced imaging modalities to improve CRT response prediction.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Cardiac resynchronization therapy (CRT) improves outcomes in heart failure (HF) with reduced ejection fraction (rEF).
- Patient selection for CRT remains challenging, with significant non-response rates.
- Optimizing CRT candidate identification is essential for improving treatment efficacy.
Purpose of the Study:
- To provide a comprehensive overview of multi-modality cardiac imaging for CRT in HFrEF.
- To explore the role of various imaging parameters in predicting CRT response and outcomes.
- To highlight advanced imaging techniques for refining patient selection.
Main Methods:
- Review of current literature on cardiac imaging modalities for CRT.
- Emphasis on echocardiography, including speckle tracking and 3D echocardiography.
- Inclusion of advanced techniques like cardiac magnetic resonance (CMR) and single-photon emission computed tomography (SPECT).
Main Results:
- Echocardiography is key for assessing cardiac dyssynchrony.
- Advanced echocardiographic techniques (speckle tracking, 3D echo, ApRock, SF) offer enhanced predictive value.
- CMR scar imaging and novel modalities like 4D flow CMR and SPECT provide additional prognostic insights.
Conclusions:
- Multi-modality cardiac imaging plays a vital role in selecting, optimizing, and predicting CRT response in HFrEF patients.
- Advanced imaging techniques show promise in refining the identification of suitable CRT candidates.
- Improved patient selection through imaging can enhance CRT outcomes and survival benefits.
Abstract:
Cardiac resynchronization therapy (CRT) offers significant benefits in symptom alleviation, reduction of rehospitalization rates, and overall survival of patients with heart failure (HF) with reduced ejection fraction (rEF). However, despite its proven efficacy, precisely identifying suitable CRT candidates remains a challenge, with a notable proportion of patients experiencing non-response. Accordingly, many attempts have been made to enhance patient selection, and to identify the best imaging parameters to predict the response and survival after CRT implantation. This review article provides a comprehensive overview on the role of multi-modality cardiac imaging in selecting, optimizing, and predicting CRT response and outcomes in HFrEF patients, beginning with an exploration of dyssynchrony types and their impact on HF progression, and an emphasis on the utility of echocardiography in assessing cardiac dyssynchrony. Subsequently, the role of advanced techniques such as speckle tracking and three-dimensional echocardiography, as well as the visual assessment of apical rocking (ApRock) and septal flash (SF) are highlighted. Finally, cardiac magnetic resonance (CMR) scar data, and novel modalities like four-dimensional flow CMR, together with single-photon emission computed tomography offer additional insights, emerging as valuable predictors of CRT response, and potentially refining the identification of suitable CRT candidates.
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