Letter by Banker et al Regarding Article, “Cardiac Resynchronization Therapy in Patients With Heart Failure and a QRS Complex <120 Milliseconds: The Evaluation of Resynchronization Therapy for Heart Failure (LESSER-EARTH) Trial”

Three-dimensional echocardiographic evaluation of mechanical dyssynchrony in systolic heart failure with narrow QRS complex

“…However, later studies did not support this concept11, 12 and recent data even suggested worsening of prognosis by CRT in HF with narrow QRS 13 . Reasons for unresponsiveness to CRT in these trials could be limitations of used imaging methods in terms of assessment of magnitude of LVMD and also in the identification of most asynchronous part of left ventricle (LV), thereby causing poor achievement of spatial concordance between the LV lead position and most delayed segment 10, 14. Although, targeted lead placement strategy is already supported by data in wide QRS patients with HF,15, 16 it is likely to be more relevant in LV dysfunction patients with narrow QRS because, as they don’t have fixed sequence of myocardial depolarization vectors determined by specific bundle branch blocks, they are expected to have more unpredictable spatial distribution of asynchronous or delayed LV segments.…”

DO VARIABLE COMPENSATION FROM CEOs HAMPER ADJUSTMENT IN COST BEHAVIOR?

“…The traditional view assumes that the behavior of costs is proportional to the level of activity (NOREEN;SODERSTROM, 1997;ANDERSON et al, 2003;BANKER;MASHRUWALA, 2008; and costs are considered fixed or variable (ATASEL; SEKER; . This traditional model assumes that costs behave symmetrically, which means that variable costs can change proportionally to changes and fixed costs remain constant regardless of changes in activities (IBRAHIM; .…”