EDUCATION IN HEART
Imaging techniques
Echocardiographic methods to select candidates for cardiac resynchronisation therapy
Med.Klinik 2, University of Erlangen, Germany
Correspondence to:
Correspondence to:
Professor Frank A Flachskampf
Med.Klinik 2, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; frank.flachskampf@rzmail.uni-erlangen.de
Keywords: cardiac resynchronisation therapy; echocardiography
| The first 150 words of the full text of this article appear below. |
The observation that heart failure with reduced ejection fraction is often accompanied by asynchronous contraction of the left ventricle, leading to a loss of mechanical efficiency in ejection and an increase in mitral regurgitation, has prompted the development of cardiac resynchronisation therapy (CRT) as a therapeutic option in symptomatic heart failure. This technique, based on pacing the left ventricle, both ventricles, or both ventricles and the right atrium, has now been shown in randomised trials to reduce morbidity and hospitalisations1 and to decrease mortality2 in symptomatic patients with reduced ejection fraction and a QRS width of 120 ms or more. In these studies, the width of the QRS complex has been used as a surrogate for cardiac mechanical asynchrony. However, following current guidelines to identify candidates, about a quarter of patients treated by CRT will lack improvement or even deteriorate ("non-responders"). On the other hand, the proportion of
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