Current Role of Echocardiography in Cardiac Resynchronization Therapy: from Cardiac Mechanics to Flow Dynamics Analysis
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IMAGING IN HEART FAILURE (J SCHULZ-MENGER, SECTION EDITOR)
Current Role of Echocardiography in Cardiac Resynchronization Therapy: from Cardiac Mechanics to Flow Dynamics Analysis Donato Mele 1
&
Filippo Trevisan 1 & Andrea Fiorencis 1 & Vittorio Smarrazzo 1 & Matteo Bertini 1 & Roberto Ferrari 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The aim of this review is to summarily explain what LV synchrony, coordination, myocardial work, and flow dynamics are, trying to clarify their advantages and limitations in the treatment of heart failure patients undergoing or with implanted cardiac resynchronization therapy (CRT). Recent Findings CRT is an established treatment for patients with heart failure and left ventricular systolic dysfunction. In the current guidelines, CRT implant indications rely only on electrical dyssynchrony, but in the last years, many aspects of cardiac mechanics (including contractile synchrony, coordination, propagation, and myocardial work) and flow dynamics have been studied using echocardiographic techniques to better characterize patients undergoing or with implanted CRT. However, the concepts, limits, and potential applications of all these echocardiographic evaluations are unclear to most clinicians. Summary The use of left ventricular dyssynchrony and discoordination indices may help to identify those significant mechanical alterations whose correction may increase the probability of a favorable CRT response. Assessment of myocardial work and intracardiac flow dynamics may overcome some limitations of the conventional evaluation of cardiac mechanics but more investigations are needed before extensive clinical application. Keywords Echocardiography . Cardiac resynchronization therapy . Mechanical dyssynchrony
Introduction Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure (HF) and left ventricular (LV) systolic dysfunction to reduce HF hospitalizations and prolong survival [1]. In HF patients undergoing CRT, echocardiography is generally used to estimate the LV ejection fraction (EF) despite its limitations [2] but it may also be utilized to assess other aspects of cardiac mechanics, such as contractile synchrony, coordination, propagation and myocardial work, and intraventricular flow dynamics [3–7]. Although all these evaluations have been repeatedly applied in patients with CRT, still their concept, limits, and advantages are unclear to most clinicians. The aim of this review is to summarily
This article is part of the Topical Collection on Imaging in Heart Failure * Donato Mele [email protected] 1
Cardiac Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124 Cona (Ferrara), Italy
explain what LV synchrony, coordination, myocardial work, and flow dynamics are, trying to clarify their current role in the treatment of HF patients undergoing CRT.
Contractile Dyssynchrony LV dyssynchrony can be defined as a significant delay of contraction between different segments of
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