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Cardiac Resynchronization Therapy: Selection of Candidates

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The ESC Textbook of Cardiovascular Imaging

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Abstract

Cardiac resynchronization therapy (CRT) is an established therapy for patients with advanced heart failure (HF), depressed left ventricular function, and wide QRS complex. A significant number of patients do not respond to CRT. Recent studies suggest that assessment of mechanical dyssynchrony may allow identification of potential CRT responders. In addition, the presence of scar tissue and venous anatomy may play a role in the selection of candidates. In this chapter the role of various cardiac imaging modalities addressing these issues in the selection of potential CRT candidates is discussed extensively.

Over the past decades, chronic HF has demonstrated an exponential increase, with a poor long-term outcome.1 Despite the advances in pharmacological therapy, including ACE inhibitors, beta-blockers, and spironolactone, mortality remains high. After the first admission for HF, the 1-year survival is 63% and the 5-year survival is only 30%.1–6 HF patients die either from progressive HF or sudden cardiac death.7 In addition to the high mortality, morbidity is also substantial, with frequent re-hospitalizations for decompensated HF 3 and extensive co-morbidity.

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Author information

Authors and Affiliations

  1. Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333, ZA, The Netherlands

    Nico R. L. Van de Veire, Ernst E. van der Wall & Jeroen J. Bax

Authors
  1. Nico R. L. Van de Veire
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  2. Ernst E. van der Wall
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  3. Jeroen J. Bax
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Editor information

Editors and Affiliations

  1. Hospital Clinico San Carlos, Instituto Cardiovascular, C/Professor Martin Lagos, s/n, 28040, Madrid, Spain

    José Luis Zamorano

  2. Medical Center Dept. Cardiology, Leiden University, Albinusdreef 2, 2333, Leiden, ZA, Netherlands

    Jeroen J. Bax

  3. Dept. Cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Frank E. Rademakers

  4. Turku PET Centre, Turku University Hospital, FI-20521, Turku, Finland

    Juhani Knuuti

Appendices

Video 20.1

Example of full volume 3D echocardiography in a heart failure patient. Left ventricular volumes are clearly dilated and LVEF is depressed (32%). From the 17 time/volume curves in 17 LV segments, the systolic dyssynchrony index is calculated (11.5%) indicating significant LV dyssynchrony

Video 20.2

Full volume 3D echocardiography is repeated post-CRT implantation. Left ventricular end-systolic volume has decreased significantly resulting in an improved systolic function (LVEF 48%). Note the resynchronization of the left ventricle, with a systolic dyssynchrony index of 1.9%

Video 20.3

Example of an invasive venogram during CRT implantation using an occlusive catheter

Video 20.4

The cardiac venous system can be evaluated non-invasively using 64-slice CT. The coronary sinus and its tributaries can be easily identified on this 3-dimensional, volume-rendered reconstruction of the heart

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Van de Veire, N.R.L., van der Wall, E.E., Bax, J.J. (2010). Cardiac Resynchronization Therapy: Selection of Candidates. In: Zamorano, J.L., Bax, J.J., Rademakers, F.E., Knuuti, J. (eds) The ESC Textbook of Cardiovascular Imaging. Springer, London. https://doi.org/10.1007/978-1-84882-421-8_20

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