ASE expert consensus statement
Echocardiography for Cardiac Resynchronization Therapy: Recommendations for Performance and Reporting–A Report from the American Society of Echocardiography Dyssynchrony Writing Group Endorsed by the Heart Rhythm Society

https://doi.org/10.1016/j.echo.2008.01.003Get rights and content

Echocardiography plays an evolving and important role in the care of heart failure patients treated with biventricular pacing, or cardiac resynchronization therapy (CRT). Numerous recent published reports have utilized echocardiographic techniques to potentially aide in patient selection for CRT prior to implantation and to optimized device settings afterwards. However, no ideal approach has yet been found. This consensus report evaluates the contemporary applications of echocardiography for CRT including relative strengths and technical limitations of several techniques and proposes guidelines regarding current and possible future clinical applications. Principal methods advised to qualify abnormalities in regional ventricular activation, known as dyssynchrony, include longitudinal velocities by color-coded tissue Doppler and the difference in left ventricular to right ventricular ejection using routine pulsed Doppler, or interventricular mechanical delay. Supplemental measures of radial dynamics which may be of additive value include septal-to-posterior wall delay using M-mode in patients with non-ischemic disease with technically high quality data, or using speckle tracking radial strain. A simplified post-CRT screening for atrioventricular optimization using Doppler mitral inflow velocities is also proposed. Since this is rapidly changing field with new information being added frequently, future modification and refinements in approach are anticipated to continue.

Keywords

Echocardiography
Doppler ultrasound
Congestive Heart Failure
Pacing Therapy

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Theodore Abraham, MD received research grants from GE Ultrasound. Jeroen Bax, MD received research grants from GE, BMS, Guidant, Medtronic, and St. Jude. Richard Grimm, DO is on the Speaker Bureau and a Consultant on the Advisory Board of Medtronic. John Gorcsan, MD received research grants from Toshiba, GE, and Siemens; and is also a Consultant on the Advisory Board of Toshiba, GE, and Siemens. Jonathan Steinberg, MD received research grants from Medtronic, St. Jude, and Boston Scientific; and he is also a Consultant on the Advisory Board of Boston Scientific. Cheuk-Man Yu, MD received research grants from GE, Medtronic, and Pfizer; and is also on the Speaker Bureau of Medtronic and GE and a Consultant on the Advisory Board of Medtronic, Boston Scientific, and GE.

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