TY - JOUR
T1 - Cardiac resynchronization therapy
T2 - Part 1 - Issues before device implantation
AU - Bax, Jeroen J.
AU - Abraham, Theodore
AU - Barold, S. Serge
AU - Breithardt, Ole A.
AU - Fung, Jeffrey W.H.
AU - Garrigue, Stephane
AU - Gorcsan, John
AU - Hayes, David L.
AU - Kass, David A.
AU - Knuuti, Juhani
AU - Leclercq, Christophe
AU - Linde, Cecilia
AU - Mark, Daniel B.
AU - Monaghan, Mark J.
AU - Nihoyannopoulos, Petros
AU - Schalij, Martin J.
AU - Stellbrink, Christophe
AU - Yu, Cheuk Man
N1 - Funding Information:
Dr. Abraham receives honoraria from GE, Guidant, Medtronic, St. Jude and receives research support from Guidant; Dr. Barold received lecture fees from receives research support from Guidant; Dr. Barold received lecture fees from Medtronic; Dr. Breithardt has been a consultant for Medtronic and Guidant and has research affiliations with Medtronic, Guidant, and GE Vingmed; Dr. Hayes is on the advisory board of Guidant Inc. and has been a speaker for Guidant Inc., Medtronic Inc., St. Jude Medical, and ELA Medical, and has received royalties from Blackwell Futura; Dr. Gorcsan received research grant support from GE, Toshiba, Siemens, Medtronic, and St. Jude; Dr. Kass has been a consultant for Guidant Inc.; Dr. Mark has been a consultant and received grants from Medtronic, Inc. Dr. Monaghan has received support from Philips, GE, Siemens, Guidant, Medtronic, and Accusphere; Dr. Schalij is on the advisory board of Guidant and has received research grants from Medtronic, Guidant, and St. Jude; Dr. Stellbrink is a sponsored investigator for Guidant, Medtronic, St. Jude, and Biotronik and is also an advisor to Guidant and Biotronik; Dr. Nihoyannopoulos received research grants and consultant fees from Medtronic.
PY - 2005/12/20
Y1 - 2005/12/20
N2 - Cardiac resynchronization therapy (CRT) has been used extensively over the last years in the therapeutic management of patients with end-stage heart failure. Data from 4,017 patients have been published in eight large, randomized trials on CRT. Improvement in clinical end points (symptoms, exercise capacity, quality of life) and echocardiographic end points (systolic function, left ventricular size, mitral regurgitation) have been reported after CRT, with a reduction in hospitalizations for decompensated heart failure and an improvement in survival. However, individual results vary, and 20% to 30% of patients do not respond to CRT. At present, the selection criteria include severe heart failure (New York Heart Association functional class III or IV), left ventricular ejection fraction <35%, and wide QRS complex (>120 ms). Assessment of inter- and particularly intraventricular dyssynchrony as provided by echocardiography (predominantly tissue Doppler imaging techniques) may allow improved identification of potential responders to CRT. In this review a summary of the clinical and echocardiographic results of the large, randomized trials is provided, followed by an extensive overview on the currently available echocardiographic techniques for assessment of LV dyssynchrony. In addition, the value of LV scar tissue and venous anatomy for the selection of potential candidates for CRT are discussed.
AB - Cardiac resynchronization therapy (CRT) has been used extensively over the last years in the therapeutic management of patients with end-stage heart failure. Data from 4,017 patients have been published in eight large, randomized trials on CRT. Improvement in clinical end points (symptoms, exercise capacity, quality of life) and echocardiographic end points (systolic function, left ventricular size, mitral regurgitation) have been reported after CRT, with a reduction in hospitalizations for decompensated heart failure and an improvement in survival. However, individual results vary, and 20% to 30% of patients do not respond to CRT. At present, the selection criteria include severe heart failure (New York Heart Association functional class III or IV), left ventricular ejection fraction <35%, and wide QRS complex (>120 ms). Assessment of inter- and particularly intraventricular dyssynchrony as provided by echocardiography (predominantly tissue Doppler imaging techniques) may allow improved identification of potential responders to CRT. In this review a summary of the clinical and echocardiographic results of the large, randomized trials is provided, followed by an extensive overview on the currently available echocardiographic techniques for assessment of LV dyssynchrony. In addition, the value of LV scar tissue and venous anatomy for the selection of potential candidates for CRT are discussed.
UR - http://www.scopus.com/inward/record.url?scp=28944443562&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2005.09.019
DO - 10.1016/j.jacc.2005.09.019
M3 - Review article
C2 - 16360042
AN - SCOPUS:28944443562
SN - 0735-1097
VL - 46
SP - 2153
EP - 2167
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 12
ER -