Imaging to improve the results of cardiac resynchronization therapy

Abstract

Novel imaging tools have the potential to increase the proportion of responders to cardiac resynchronization therapy (CRT). Echocardiographic techniques, especially those based on tissue Doppler, may help to assess and quantify mechanical dyssynchrony and thus enable better selection of candidates for CRT. However, available echocardiographic techniques do not appear to be ready for routine practice, because of high intraobserver and interobserver variability (as demonstrated in the PROSPECT trial). Other methods to evaluate mechanical dyssynchrony include MRI and/or nuclear imaging, and both strategies are being intensively studied. Assessment of venous anatomy using computed tomography angiography, rotational angiography and/or MRI may help to improve implant rates and increase skills of the implanters, especially when integrated with online fluoroscopy. Some of the aforementioned techniques may also help to optimize left ventricular lead positioning. Evaluation of myocardial scars using MRI and/or sing...