Value of Baseline Left Lateral Wall Postsystolic Displacement Assessed by M-Mode to Predict Reverse Remodeling by Cardiac Resynchronization Therapy

Sassone, Biagio; Capecchi, Alessandro; Boggian, Giulio; Gabrieli, Luca; Saccà, Saverio; Vandelli, R.; Petracci, Elisabetta; Mele, Donato

doi:10.1016/j.amjcard.2007.02.107

Cited by 16 publications

(9 citation statements)

References 29 publications

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“…A number of small, single-center studies observed no correlation between remodeling after CRT and IVMD, assessed using conventional or tissue Doppler (21,51,63). However, in other reports, IVMD predicted both clinical and volumetric response (45,94,95).…”

Section: Predicting Response To Therapymentioning

confidence: 96%

“…Septal motion reflects interventricular in addition to intraventricular dyssynchrony (51). Feasibility is variably reported between 55% and 100% (23,30,51,(53)(54)(55)(56). Maximal septal or posterior wall motion is often diminished or absent in ischemic populations, causing inaccurate assessment (23,51,54,55).…”

Section: How Do We Measure Mechanical Dyssynchrony Using Echocardiogrmentioning

confidence: 98%

“…It is 1-dimensional, comparing only 2 basal segments and neglecting the more frequently delayed lateral wall. Septal motion reflects interventricular in addition to intraventricular dyssynchrony (51). Feasibility is variably reported between 55% and 100% (23,30,51,(53)(54)(55)(56).…”

Section: How Do We Measure Mechanical Dyssynchrony Using Echocardiogrmentioning

confidence: 99%

“…Prolonged RVPEP in pulmonary hypertension or right ventricular dysfunction reduces IVMD and accuracy of assessment (50). Left lateral wall diastolic contraction describes delayed lateral wall contraction (using M-mode) after onset of diastolic filling (transmitral Doppler E-wave onset) (10,49,51,52). Coexistence of post-systolic contraction and diastolic relaxation signifies severe intraventricular dyssynchrony.…”

Section: How Do We Measure Mechanical Dyssynchrony Using Echocardiogrmentioning

confidence: 99%

“…Septal-to-posterior wall motion delay (SPWMD) measures time between maximal incursion of the septum and posterior wall on M-mode, with a delay Ն130 ms considered significant intraventricular dyssynchrony (23,30,51,(53)(54)(55)(56). Many drawbacks to SPWMD exist.…”

Section: How Do We Measure Mechanical Dyssynchrony Using Echocardiogrmentioning

confidence: 99%

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Selecting Patients for Cardiac Resynchronization Therapy

Hawkins

Petrie

Burgess

et al. 2009

Journal of the American College of Cardiology

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Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with heart failure. International guidelines unanimously endorse QRS prolongation to identify candidates for implantation, based on over 4,000 patients randomized in landmark trials. Small, observational, nonrandomized studies with surrogate end points have promoted echocardiography as a superior method of patient selection. Over 30 dyssynchrony parameters have been proposed. Most lack validation in appropriate clinical settings, including demonstration of short- and long-term reproducibility and intra- and interobserver variability. Prospective multicenter trials have proved informative in unexpected ways. In core laboratories, parameters exhibit striking variability, poor reproducibility, and limited predictive power. We are concerned that many centers today are using these techniques to select patients for CRT. Publication density and bias have misinformed clinical decision making. Echocardiographic parameters have no place in denying potentially life-saving treatment or in exposing patients to unnecessary risks and draining health care resources. Such measures should not stray beyond the research environment unless validated in randomized trials with robust clinical end points. The electrocardiogram remains a simple, inexpensive, and reproducible tool that identifies patients likely to benefit from CRT. Patient selection must use the parameter prospectively validated in landmark clinical trials: the QRS duration.

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Section: Predicting Response To Therapymentioning

confidence: 96%

Section: How Do We Measure Mechanical Dyssynchrony Using Echocardiogrmentioning

confidence: 98%

Section: How Do We Measure Mechanical Dyssynchrony Using Echocardiogrmentioning

confidence: 99%

Section: How Do We Measure Mechanical Dyssynchrony Using Echocardiogrmentioning

confidence: 99%

Section: How Do We Measure Mechanical Dyssynchrony Using Echocardiogrmentioning

confidence: 99%

See 3 more Smart Citations

Selecting Patients for Cardiac Resynchronization Therapy

Hawkins

Petrie

Burgess

et al. 2009

Journal of the American College of Cardiology

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Strategies for Restoring Cardiac Synchrony by Cardiac Pacing

Cristian

Bontaș²,

Chiriac

et al. 2013

Cardiac Arrhythmias

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Kardiale Resynchronisationstherapie: Präoperatives Screening

Kindermann

Mahfoud²,

Ukena³

et al. 2009

Herzschr. Elektrophys.

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Cardiac resynchronization therapy (CRT) is an established therapy for patients with advanced heart failure, depressed left ventricular function, and wide QRS complex. However, about 30 to 45% of patients do not respond to CRT. Assuming that the main therapeutic action of CRT is the correction of dyssynchronous myocardial contraction, a plethora of echocardiographic dyssynchrony parameters have been proposed to improve the prediction of response to CRT. However, one multicenter study has recently questioned the utility of any of these indexes. This review delineates the various causes of non-response to CRT, explains the different levels and mechanisms of dyssynchrony and gives a critical overview of currently available echocardiographic techniques for assessment of dyssynchrony. Based upon a discussion of the evidence coming from randomized multicenter studies and against the background of national and international cardiac societies' guideline recommendations on CRT, a rational basis for the evaluation of patients for CRT is proposed.

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Value of Baseline Left Lateral Wall Postsystolic Displacement Assessed by M-Mode to Predict Reverse Remodeling by Cardiac Resynchronization Therapy

Cited by 16 publications

References 29 publications

Selecting Patients for Cardiac Resynchronization Therapy

Selecting Patients for Cardiac Resynchronization Therapy

Strategies for Restoring Cardiac Synchrony by Cardiac Pacing

Kardiale Resynchronisationstherapie: Präoperatives Screening

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