Relationship of visually assessed apical rocking and septal flash to response and long-term survival following cardiac resynchronization therapy (PREDICT-CRT)

Stanković, Ivan; Prinz, Christian; Ciarka, Agnieszka; Daraban, Ana Maria; Kotrč, Martin; Aarones, Marit; Szulik, Mariola; Winter, Stefan; Belmans, Ann; Nešković, Aleksandar N.; Kukulski, Tomasz; Aakhus, Svend; Willems, Rik; Fehske, Wolfgang; Pěnička, Martin; Faber, Lothar; Voigt, Jens‐Uwe

doi:10.1093/ehjci/jev288

Cited by 191 publications

(149 citation statements)

References 38 publications

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“…An example of this is ‘septal flash’: the abnormal brief inward septal motion that occurs during the isovolumic contraction time and which characterises LBBB-related dyssynchrony. An observational study of over 1000 patients (PREDICT-CRT) demonstrated that the presence of apical rocking and septal flash had an incremental value over clinical variables and QRS width for identifying CRT responders (21). In addition, their absence or unsuccessful correction was associated with a high risk for non-response and unfavourable long-term survival.…”

Section: Echocardiographic Assessment Of LV Dyssynchronymentioning

confidence: 99%

Clinical utility of speckle-tracking echocardiography in cardiac resynchronisation therapy

et al. 2016

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Cardiac resynchronisation therapy (CRT) can profoundly improve outcome in selected patients with heart failure; however, response is difficult to predict and can be absent in up to one in three patients. There has been a substantial amount of interest in the echocardiographic assessment of left ventricular dyssynchrony, with the ultimate aim of reliably identifying patients who will respond to CRT. The measurement of myocardial deformation (strain) has conventionally been assessed using tissue Doppler imaging (TDI), which is limited by its angle dependence and ability to measure in a single plane. Two-dimensional speckle-tracking echocardiography is a technique that provides measurements of strain in three planes, by tracking patterns of ultrasound interference (‘speckles’) in the myocardial wall throughout the cardiac cycle. Since its initial use over 15 years ago, it has emerged as a tool that provides more robust, reproducible and sensitive markers of dyssynchrony than TDI. This article reviews the use of two-dimensional and three-dimensional speckle-tracking echocardiography in the assessment of dyssynchrony, including the identification of echocardiographic parameters that may hold predictive potential for the response to CRT. It also reviews the application of these techniques in guiding optimal LV lead placement pre-implant, with promising results in clinical improvement post-CRT.

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Section: Echocardiographic Assessment Of LV Dyssynchronymentioning

confidence: 99%

Clinical utility of speckle-tracking echocardiography in cardiac resynchronisation therapy

et al. 2016

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“…Apical rocking in multivariable analyses has been associated with fewer major adverse cardiac events in patients receiving CRT . In the recent PREDICT‐CRT trial, absence of apical rocking and unsuccessful correction of the septal flash were associated with a high risk for CRT failure and unfavorable long‐term survival . Unfortunately, inter‐observer agreement for both apical rocking and septal flash was only moderate, with a Kappa value of 0.71, indicating that the assessment of these parameters may not be sufficient in routine practice.…”

Section: Identification Of Electromechanical Dyssynchrony By Echocardmentioning

confidence: 92%

Role of echocardiography before cardiac resynchronization therapy: new advances and current developments

et al. 2016

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The role of echocardiography in improving the selection of patients who will benefit from cardiac resynchronization therapy (CRT) remains a source of debate. Although previous landmark reports have demonstrated a link between mechanical dyssynchrony, assessed by delays between left ventricle (LV) walls and response to CRT, the predictive value of these findings has not yet been confirmed in multicenter trials. Indeed, recent studies demonstrated that the classical assessment of LV mechanical dyssynchrony using delay between walls by echocardiography depends not only on LV electrical activation delay (electrical dyssynchrony), but also on abnormalities in regional contractility of the LV and/or loading conditions, which do not represent an appropriate target for CRT. Recent reports highlighted the value of new indices of electromechanical dyssynchrony obtained by echocardiography, to predict LV response and outcome after CRT including septal flash, left bundle branch block-typical pattern by longitudinal strain, apical rocking, septal strain patterns, and systolic stretch index. This was achieved using a mechanistic approach, based on the contractile consequences of electrical dyssynchrony. These indices are rarely found in patients with narrow QRS (<120 ms), whereas their frequency rises in patients with an increase in QRS duration (>120 ms). Theses indices should improve candidate selection for CRT in clinical practice, especially for patients in whom the benefit of CRT remains uncertain, for example, patients with intermediate QRS width (120-150 ms).

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“…The septal flash occurs in the presence of LBBB and is a rapid right‐to‐left motion of the interventricular septum (followed by a rapid return to the right) during the initial (isovolumetric) phase of systole (within the limits of QRS duration) (Figure ). Generally, patients with large septal flash also have a U‐shaped activation and respond better to CRT compared to those with no or little septal flash …”

Section: Septal Flash Septal Rebound Stretch and Apical Rockingmentioning

confidence: 99%

“…Generally, patients with large septal flash also have a U-shaped activation and respond better to CRT compared to those with no or little septal flash. 28,29 The septal rebound stretch is defined as the systolic septal elongation after the initial shortening. 30 Although septal flash and septal rebound stretch are associated in LBBB, their mechanism is different.…”

Section: S Ep Tal Fl a S H S Ep Tal Rebound S Tre Tch And Api Cmentioning

confidence: 99%

Echocardiographic evaluation of cardiac dyssynchrony: Does it still matter?

et al. 2018

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Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure and left ventricular systolic dysfunction. For many years, cardiac mechanical dyssynchrony assessed by echocardiography has been considered as a key evaluation to characterize CRT candidates and predict CRT response. In current guidelines, however, CRT implant indications rely only on electrical dyssynchrony. The aim of this article was to clarify whether and how the evaluation of cardiac mechanical dyssynchrony should be performed today by echocardiography.

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Relationship of visually assessed apical rocking and septal flash to response and long-term survival following cardiac resynchronization therapy (PREDICT-CRT)

Abstract: A specific LV mechanical dyssynchrony pattern, characterized by ApRock and SF, is associated with a more favourable long-term survival after CRT. Both parameters are also indicators of an effective therapy.

Cited by 191 publications

References 38 publications

Clinical utility of speckle-tracking echocardiography in cardiac resynchronisation therapy

Clinical utility of speckle-tracking echocardiography in cardiac resynchronisation therapy

Role of echocardiography before cardiac resynchronization therapy: new advances and current developments

Echocardiographic evaluation of cardiac dyssynchrony: Does it still matter?

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