Skip to main content
SpringerLink
Log in

Echocardiography in Cardiac Resynchronization Therapy

  • Chapter
  • First Online:
Echocardiography

  • 2909 Accesses

Abstract

Cardiac resynchronization therapy (CRT) is an established treatment of heart failure patients who remain symptomatic despite optimal medical treatment, have reduced left ventricular ejection fraction and show broad QRS on surface electrocardiogram. Selection of patients who will benefit from CRT remains challenging and is the focus of ongoing research. Cardiac imaging techniques have provided important pathophysiologic data on the mechanism of action of this therapy, and the factors associated with less benefit of CRT. Cardiac dyssynchrony, extent and location of transmural myocardial scar and position of the left ventricular pacing lead are the main determinants of CRT response. Furthermore, CRT pacing settings can be programmed to obtain the maximum benefit from the therapy. Although optimization of CRT with imaging techniques remains controversial, understanding how changes in CRT settings impact on cardiac hemodynamics may help us to select the most appropriate atrioventricular and interventricular delays. This book chapter provides an overview of the recent advances in imaging techniques to select heart failure patients for CRT and summarizes the echocardiographic techniques that can be used for CRT optimization.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the heart failure association (HFA) of the ESC. Eur Heart J. 2012;33(14):1787–847.

    Article  Google Scholar 

  2. Abraham WT, Hayes DL. Cardiac resynchronization therapy for heart failure. Circulation. 2003;108(21):2596–603.

    Article  Google Scholar 

  3. Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De MT, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350(21):2140–50.

    Article  CAS  Google Scholar 

  4. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352(15):1539–49.

    Article  CAS  Google Scholar 

  5. Daubert C, Gold MR, Abraham WT, Ghio S, Hassager C, Goode G, et al. Prevention of disease progression by cardiac resynchronization therapy in patients with asymptomatic or mildly symptomatic left ventricular dysfunction: insights from the European cohort of the REVERSE (resynchronization reverses Remodeling in systolic left ventricular dysfunction) trial. J Am Coll Cardiol. 2009;54(20):1837–46.

    Article  Google Scholar 

  6. Linde C, Abraham WT, Gold MR, St John SM, Ghio S, Daubert C. Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. J Am Coll Cardiol. 2008;52(23):1834–43.

    Article  Google Scholar 

  7. Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009;361(14):1329–38.

    Article  Google Scholar 

  8. Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S, et al. Cardiac-resynchronization therapy for mild-to-moderate heart failure. N Engl J Med. 2010;363(25):2385–95.

    Article  CAS  Google Scholar 

  9. Bilchick KC, Kamath S, DiMarco JP, Stukenborg GJ. Bundle-branch block morphology and other predictors of outcome after cardiac resynchronization therapy in Medicare patients. Circulation. 2010;122(20):2022–30.

    Article  Google Scholar 

  10. Delgado V, Bax JJ. Assessment of systolic dyssynchrony for cardiac resynchronization therapy is clinically useful. Circulation. 2011;123(6):640–55.

    Article  Google Scholar 

  11. Gorcsan J III, Oyenuga O, Habib PJ, Tanaka H, Adelstein EC, Hara H, et al. Relationship of echocardiographic dyssynchrony to long-term survival after cardiac resynchronization therapy. Circulation. 2010;122(19):1910–8.

    Article  Google Scholar 

  12. Zareba W, Klein H, Cygankiewicz I, Hall WJ, McNitt S, Brown M, et al. Effectiveness of cardiac resynchronization therapy by QRS morphology in the Multicenter automatic defibrillator implantation trial-cardiac resynchronization therapy (MADIT-CRT). Circulation. 2011;123(10):1061–72.

    Article  Google Scholar 

  13. Gervais R, Leclercq C, Shankar A, Jacobs S, Eiskjaer H, Johannessen A, et al. Surface electrocardiogram to predict outcome in candidates for cardiac resynchronization therapy: a sub-analysis of the CARE-HF trial. Eur J Heart Fail. 2009;11(7):699–705.

    Article  Google Scholar 

  14. Auricchio A, Fantoni C, Regoli F, Carbucicchio C, Goette A, Geller C, et al. Characterization of left ventricular activation in patients with heart failure and left bundle-branch block. Circulation. 2004;109(9):1133–9.

    Article  Google Scholar 

  15. Chung ES, Leon AR, Tavazzi L, Sun JP, Nihoyannopoulos P, Merlino J, et al. Results of the predictors of response to CRT (PROSPECT) trial. Circulation. 2008;117(20):2608–16.

    Article  Google Scholar 

  16. Bax JJ, Gorcsan J III. Echocardiography and noninvasive imaging in cardiac resynchronization therapy: results of the PROSPECT (predictors of response to cardiac resynchronization therapy) study in perspective. J Am Coll Cardiol. 2009;53(21):1933–43.

    Article  Google Scholar 

  17. Bilchick KC, Dimaano V, Wu KC, Helm RH, Weiss RG, Lima JA, et al. Cardiac magnetic resonance assessment of dyssynchrony and myocardial scar predicts function class improvement following cardiac resynchronization therapy. JACC Cardiovasc Imaging. 2008;1(5):561–8.

    Article  Google Scholar 

  18. Delgado V, Van Bommel RJ, Bertini M, Borleffs CJ, Marsan NA, Arnold CT, et al. Relative merits of left ventricular dyssynchrony, left ventricular lead position, and myocardial scar to predict long-term survival of ischemic heart failure patients undergoing cardiac resynchronization therapy. Circulation. 2011;123(1):70–8.

    Article  Google Scholar 

  19. Leyva F, Foley PW, Chalil S, Ratib K, Smith RE, Prinzen F, et al. Cardiac resynchronization therapy guided by late gadolinium-enhancement cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2011;13:29.

    Article  Google Scholar 

  20. Duckett SG, Ginks MR, Knowles BR, Ma Y, Shetty A, Bostock J, et al. Advanced image fusion to overlay coronary sinus anatomy with real-time fluoroscopy to facilitate left ventricular lead implantation in CRT. Pacing Clin Electrophysiol. 2011;34(2):226–34.

    Article  Google Scholar 

  21. Uebleis C, Ulbrich M, Tegtmeyer R, Schuessler F, Haserueck N, Siebermair J, et al. Electrocardiogram-gated 18F-FDG PET/CT hybrid imaging in patients with unsatisfactory response to cardiac resynchronization therapy: initial clinical results. J Nucl Med. 2011;52(1):67–71.

    Article  Google Scholar 

  22. Auger D, Hoke U, Bax JJ, Boersma E, Delgado V. Effect of atrioventricular and ventriculoventricular delay optimization on clinical and echocardiographic outcomes of patients treated with cardiac resynchronization therapy: a meta-analysis. Am Heart J. 2013;166(1):20–9.

    Article  Google Scholar 

  23. Sipahi I, Carrigan TP, Rowland DY, Stambler BS, Fang JC. Impact of QRS duration on clinical event reduction with cardiac resynchronization therapy: meta-analysis of randomized controlled trials. Arch Intern Med. 2011;171(16):1454–62.

    Article  Google Scholar 

  24. Baldasseroni S, Opasich C, Gorini M, Lucci D, Marchionni N, Marini M, et al. Left bundle-branch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: a report from the Italian network on congestive heart failure. Am Heart J. 2002;143(3):398–405.

    Article  Google Scholar 

  25. Shanks M, Delgado V, Ng AC, Auger D, Mooyaart EA, Bertini M, et al. Clinical and echocardiographic predictors of nonresponse to cardiac resynchronization therapy. Am Heart J. 2011;161(3):552–7.

    Article  Google Scholar 

  26. Suffoletto MS, Dohi K, Cannesson M, Saba S, Gorcsan J III. Novel speckle-tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy. Circulation. 2006;113(7):960–8.

    Article  Google Scholar 

  27. Delgado V, Ypenburg C, Van Bommel RJ, Tops LF, Mollema SA, Marsan NA, et al. Assessment of left ventricular dyssynchrony by speckle tracking strain imaging. Comparison between longitudinal, circumferential, and radial strain in cardiac resynchronization therapy. J Am Coll Cardiol. 2008;51(20):1944–52.

    Article  Google Scholar 

  28. Lim P, Buakhamsri A, Popovic ZB, Greenberg NL, Patel D, Thomas JD, et al. Longitudinal strain delay index by speckle tracking imaging: a new marker of response to cardiac resynchronization therapy. Circulation. 2008;118(11):1130–7.

    Article  Google Scholar 

  29. Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr. 2011;24(3):277–313.

    Article  Google Scholar 

  30. Kleijn SA, Aly MF, Knol DL, Terwee CB, Jansma EP, Abd El-Hady YA, et al. A meta-analysis of left ventricular dyssynchrony assessment and prediction of response to cardiac resynchronization therapy by three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging. 2012;13(9):763–75.

    Article  Google Scholar 

  31. van de Veire NR, Bleeker GB, De SJ, Ypenburg C, Holman ER, van der Wall EE, et al. Tissue synchronisation imaging accurately measures left ventricular dyssynchrony and predicts response to cardiac resynchronisation therapy. Heart. 2007;93(9):1034–9.

    Article  Google Scholar 

  32. Tanaka H, Hara H, Saba S, Gorcsan J III. Usefulness of three-dimensional speckle tracking strain to quantify dyssynchrony and the site of latest mechanical activation. Am J Cardiol. 2010;105(2):235–42.

    Article  Google Scholar 

  33. Thebault C, Donal E, Bernard A, Moreau O, Schnell F, Mabo P, et al. Real-time three-dimensional speckle tracking echocardiography: a novel technique to quantify global left ventricular mechanical dyssynchrony. Eur J Echocardiogr. 2011;12(1):26–32.

    Article  Google Scholar 

  34. Tatsumi K, Tanaka H, Tsuji T, Kaneko A, Ryo K, Yamawaki K, et al. Strain dyssynchrony index determined by three-dimensional speckle area tracking can predict response to cardiac resynchronization therapy. Cardiovasc Ultrasound. 2011;9:11.

    Article  Google Scholar 

  35. Chalil S, Stegemann B, Muhyaldeen S, Khadjooi K, Smith RE, Jordan PJ, et al. Intraventricular dyssynchrony predicts mortality and morbidity after cardiac resynchronization therapy: a study using cardiovascular magnetic resonance tissue synchronization imaging. J Am Coll Cardiol. 2007;50(3):243–52.

    Article  Google Scholar 

  36. Boogers MM, Van Kriekinge SD, Henneman MM, Ypenburg C, Van Bommel RJ, Boersma E, et al. Quantitative gated SPECT-derived phase analysis on gated myocardial perfusion SPECT detects left ventricular Dyssynchrony and predicts response to cardiac resynchronization therapy. J Nucl Med. 2009;50(5):718–25.

    Article  Google Scholar 

  37. Khan FZ, Virdee MS, Palmer CR, Pugh PJ, O’Halloran D, Elsik M, et al. Targeted left ventricular lead placement to guide cardiac resynchronization therapy: the TARGET study: a randomized, controlled trial. J Am Coll Cardiol. 2012;59(17):1509–18.

    Article  Google Scholar 

  38. Saba S, Marek J, Schwartzman D, Jain S, Adelstein E, White P, et al. Echocardiography-guided left ventricular lead placement for cardiac resynchronization therapy: results of the speckle tracking assisted resynchronization therapy for electrode region (STARTER) trial. Circ Heart Fail. 2013;6(3):8.

    Article  Google Scholar 

  39. Ypenburg C, Van Bommel RJ, Delgado V, Mollema SA, Bleeker GB, Boersma E, et al. Optimal left ventricular lead position predicts reverse remodeling and survival after cardiac resynchronization therapy. J Am Coll Cardiol. 2008;52(17):1402–9.

    Article  Google Scholar 

  40. van de Veire NR, Schuijf JD, De SJ, Devos D, Bleeker GB, de RA, et al. Non-invasive visualization of the cardiac venous system in coronary artery disease patients using 64-slice computed tomography. J Am Coll Cardiol. 2006;48(9):1832–8.

    Article  Google Scholar 

  41. Girsky MJ, Shinbane JS, Ahmadi N, Mao S, Flores F, Budoff MJ. Prospective randomized trial of venous cardiac computed tomographic angiography for facilitation of cardiac resynchronization therapy. Pacing Clin Electrophysiol. 2010;33(10):1182–7.

    Article  Google Scholar 

  42. Wikstrom G, Blomstrom-Lundqvist C, Andren B, Lonnerholm S, Blomstrom P, Freemantle N, et al. The effects of aetiology on outcome in patients treated with cardiac resynchronization therapy in the CARE-HF trial. Eur Heart J. 2009;30(7):782–8.

    Article  Google Scholar 

  43. Adelstein EC, Tanaka H, Soman P, Miske G, Haberman SC, Saba SF, et al. Impact of scar burden by single-photon emission computed tomography myocardial perfusion imaging on patient outcomes following cardiac resynchronization therapy. Eur Heart J. 2011;32(1):93–103.

    Article  Google Scholar 

  44. Marsan NA, Westenberg JJ, Ypenburg C, Van Bommel RJ, Roes S, Delgado V, et al. Magnetic resonance imaging and response to cardiac resynchronization therapy: relative merits of left ventricular dyssynchrony and scar tissue. Eur Heart J. 2009;30(19):2360–7.

    Article  Google Scholar 

  45. Xu YZ, Cha YM, Feng D, Powell BD, Wiste HJ, Hua W, et al. Impact of myocardial scarring on outcomes of cardiac resynchronization therapy: extent or location? J Nucl Med. 2012;53(1):47–54.

    Article  Google Scholar 

  46. Becker M, Hoffmann R, Kuhl HP, Grawe H, Katoh M, Kramann R, et al. Analysis of myocardial deformation based on ultrasonic pixel tracking to determine transmurality in chronic myocardial infarction. Eur Heart J. 2006;27(21):2560–6.

    Article  Google Scholar 

  47. Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, et al. 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European heart rhythm association (EHRA). Eur Heart J. 2013;34:24.

    Article  Google Scholar 

  48. Mullens W, Grimm RA, Verga T, Dresing T, Starling RC, Wilkoff BL, et al. Insights from a cardiac resynchronization optimization clinic as part of a heart failure disease management program. J Am Coll Cardiol. 2009;53(9):765–73.

    Article  Google Scholar 

  49. Bertini M, Delgado V, Bax JJ, van de Veire NR. Why, how and when do we need to optimize the setting of cardiac resynchronization therapy? Europace. 2009;11(Suppl 5):v46–57.

    Article  Google Scholar 

  50. Ellenbogen KA, Gold MR, Meyer TE, Fernndez LI, Mittal S, Waggoner AD, et al. Primary results from the SmartDelay determined AV optimization: a comparison to other AV delay methods used in cardiac resynchronization therapy (SMART-AV) trial: a randomized trial comparing empirical, echocardiography-guided, and algorithmic atrioventricular delay programming in cardiac resynchronization therapy. Circulation. 2010;122(25):2660–8.

    Article  Google Scholar 

  51. Vidal B, Sitges M, Marigliano A, Delgado V, Diaz-Infante E, Azqueta M, et al. Optimizing the programation of cardiac resynchronization therapy devices in patients with heart failure and left bundle branch block. Am J Cardiol. 2007;100(6):1002–6.

    Article  Google Scholar 

  52. Doring M, Braunschweig F, Eitel C, Gaspar T, Wetzel U, Nitsche B, et al. Individually tailored left ventricular lead placement: lessons from multimodality integration between three-dimensional echocardiography and coronary sinus angiogram. Europace. 2013;15(5):718–27.

    Article  Google Scholar 

  53. Nitsche B, Eitel C, Bode K, Wetzel U, Richter S, Doring M, et al. Left ventricular wall motion analysis to guide management of CRT non-responders. Europace. 2015;17(5):778–86.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

    Ulas Höke, Jeroen J. Bax, Nina Ajmone Marsan & Victoria Delgado

Authors
  1. Ulas Höke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeroen J. Bax
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nina Ajmone Marsan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Victoria Delgado
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeroen J. Bax .

Editor information

Editors and Affiliations

  1. Hammersmith Hospital, Imperial College London National Heart & Lung Institute, London, UK

    Petros Nihoyannopoulos

  2. Duke Heart Center, Duke University Medical Center, Durham, NC, USA

    Joseph Kisslo

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Höke, U., Bax, J.J., Ajmone Marsan, N., Delgado, V. (2018). Echocardiography in Cardiac Resynchronization Therapy. In: Nihoyannopoulos, P., Kisslo, J. (eds) Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-319-71617-6_26

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-71617-6_26

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-71615-2

  • Online ISBN: 978-3-319-71617-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation