Heart

Lane, R E; Chow, A W C; Chin, D; Mayet, J

doi: 10.1136/hrt.2004.043000pmid: 15564419

The quantification of ventricular dyssynchrony is a key factor in identifying patients with severe heart failure who may benefit from cardiac resynchronisation with biventricular pacing (BVP). Echocardiographic techniques appear to offer superior sensitivity and specificity than the ECG in selecting these patients. This paper reviews the scope of current echocardiographic techniques for guiding both patient selection and optimisation of device programming following implantation.

Bleasdale, R A; Frenneaux, M P

doi: 10.1136/hrt.2004.048546pmid: 15564421

Becher, H; Chambers, J; Fox, K; Jones, R; Leech, G J; Masani, N; Monaghan, M; More, R; Nihoyannopoulos, P; Rimington, H; Senior, R; Warton, G

doi: 10.1136/hrt.2004.047985pmid:

Nesser, H J; Breithardt, O-A; Khandheria, B K

doi: 10.1136/hrt.2004.047167pmid: 15564424

Randomised trials involving large number of patients have demonstrated the benefits of cardiac resynchronisation therapy (CRT) in patients with heart failure who have failed optimal medical treatment. Echocardiography plays an important role in defining dyssynchrony which is key to optimal patient selection. The electrocardiographic criteria for patient selection is supplemented by the finding of dyssynchrony on Doppler myocardial imaging, and echocardiography with Doppler myocardial imaging may eventually replace the electrocardiographic criteria for selection of patients who derive benefit from CRT.

Yu, C M; Bax, J J; Monaghan, M; Nihoyannopoulos, P

doi: 10.1136/hrt.2004.048322pmid: 15564420

Cardiac resynchronisation therapy (CRT) is an established therapy for patients with heart failure with wide QRS duration. Recent studies observed that assessment of systolic dyssynchrony is an important diagnostic tool as the treatment involves the re-coordination of regional wall contraction within the left ventricle. Therefore, the effectiveness of CRT depends heavily on whether systolic dyssynchrony is present before the treatment. Echocardiography is a useful tool for quantitative measurement of the severity of dyssynchrony in these patients before and after CRT. A number of echocardiographic tools have been developed during the past three years for such purpose, include M mode measurement of septal-to-posterior wall delay, tissue Doppler imaging for septal-to-lateral wall delay, the measurement of standard deviation of peak contraction time over 12 left ventricular segments, delayed longitudinal contraction, and potentially three dimensional echocardiography. This review discusses the potential role of various echocardiographic techniques in the assessment of systolic dyssynchrony and their clinical applications.