NDLI: The role of echocardiography in quantification of left ventricular dyssynchrony: state of the art and future directions.

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The role of echocardiography in quantification of left ventricular dyssynchrony: state of the art and future directions.

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The role of echocardiography in quantification of left ventricular dyssynchrony: state of the art and future directions.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Smiseth, Otto A. Russell, Kristoffer Skulstad, Helge
Description	Country affiliation: Norway Author Affiliation: Smiseth OA ( Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology and Institute for Surgical Research, Oslo University Hospital, University of Oslo, Rikshospitalet, N-0027 Oslo, Norway. otto.smiseth@ous-hf.no)
Abstract	This article discusses how echocardiography can be applied to quantify dyssynchrony in patients who are evaluated for cardiac resynchronization therapy (CRT). A number of echocardiographic indices have been proposed as markers of success of CRT. However, when tested against QRS width in prospective clinical trials, none of the echocardiographic indices are proven to give clinical benefit. One important message in this review is that future studies should focus on approaches which can differentiate between electrical and non-electrical aetiologies of dyssynchrony, since only electrical dyssynchrony is likely to respond to CRT. Just measuring velocity indices does not identify the aetiology. Myocardial strain appears more promising, but one should be aware that timing of peak systolic strain is determined not only by electrical conduction. It is proposed to use onset septal shortening during pre-ejection for timing of earliest left ventricular (LV) electrical activation. One should take into account potential ischaemia, scarring, and other structural changes as contributors to dyssynchrony. As a method to identify electrical dyssynchrony, the authors propose to use time of active force generation as defined by LV pressure-strain loops. A non-invasive method to measure segmental pressure-strain loops is also proposed as a means to quantify the impact of dyssynchrony on distribution of myocardial work. Furthermore, it is important to be aware that LV dyssynchrony may have a combination of aetiologies, not all amenable for CRT.
File Format	HTM / HTML
ISSN	20472404
e-ISSN	20472412
Journal	European Heart Journal - Cardiovascular Imaging features
Issue Number	1
Volume Number	13
Language	English
Publisher	Oxford University Press
Publisher Date	2012-01-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Discipline Cardiology Cardiac Resynchronization Therapy Echocardiography Heart Ventricles Ventricular Dysfunction, Left Biological Markers Pathology Prognosis Stroke Volume Systole Therapy Ventricular Function, Left Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Radiology, Nuclear Medicine and Imaging Cardiology and Cardiovascular Medicine

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