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(Circulation. 2008;117:2009-2023.)
© 2008 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Patient Selection and Echocardiographic Assessment of Dyssynchrony in Cardiac Resynchronization Therapy

Lisa J. Anderson, MD; Chinami Miyazaki, MD; George R. Sutherland, MD, PhD; Jae K. Oh, MD

From the Department of Cardiology, St. George’s Hospital, London, United Kingdom (L.J.A., G.R.S.); and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn (C.M., J.K.O.).

Correspondence to Jae K. Oh, MD, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905. E-mail oh.jae@mayo.edu

Key Words: echocardiography • heart failure • pacemakers • pacing

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Appropriate cardiac resynchronization therapy (CRT) enhances quality of life and improves survival in patients with refractory heart failure due to systolic dysfunction and mechanical dyssynchrony. On the assumption that the main therapeutic mechanism of CRT is the correction of dyssynchronous myocardial contraction, imaging-based measures of dyssynchrony have been intensely investigated with the aim of predicting response to therapy. Numerous echocardiographic dyssynchrony parameters have been proposed, but no large prospective trial have been published to prove the clinical utility of any of these indexes. Moreover, the methodology to derive the proposed dyssynchrony indexes has not been standardized. Therefore, the purpose of this article is to critically review the current status of proposed dyssynchrony indexes by echocardiography for patient selection and to recommend future investigations in this area.

	CRT: From Origins to Routine Clinical Practice

 
The adverse effects of dyssychronous activation¹ and the ability to correct these abnormalities with biventricular stimulation² were described long ago, but the potential therapeutic application was not realized until an unprecedented study in 1990 reported recovery from intractable heart failure in 16 patients implanted with conventional dual-chamber pacemakers programmed to a short atrioventricular (AV) delay.³ Although these results could not be reproduced in prospective studies^4,5 and improvements could only be demonstrated short-term in highly selected patients,⁶ the race to find a pacing therapy for heart failure had begun.

On the hypothesis that the disappointing results of dual-chamber pacing in prospective studies were due to cancelling or overcoming the beneficial effects of AV synchronisation by the adverse effect of RV pacing-induced dyssynchrony,^7,8 Cazeau and colleagues . . . [Full Text of this Article]

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