Our mission is to become a worldwide reference for education in the field for all professionals involved in the process to disseminate knowledge & skills of Acute Cardiovascular Care.
Our mission is to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular imaging in Europe.
Our mission is to promote excellence in research, practice, education and policy in cardiovascular health, primary and secondary prevention.
Our mission is to reduce the burden of cardiovascular disease through percutaneous cardiovascular interventions.
Our mission is to improve the quality of life of the population by reducing the impact of cardiac rhythm disturbances and reduce sudden cardiac death.
Our mission is to improve quality of life and longevity, through better prevention, diagnosis and treatment of heart failure, including the establishment of networks for its management, education and research.
The ESC Working Groups' goal is to stimulate and disseminate scientific knowledge in different fields of cardiology.
The ESC Councils' goal is to share knowledge among medical professionals practising in specific cardiology domains.
OUR MISSION: TO REDUCE THE BURDEN OF CARDIOVASCULAR DISEASE
Ms Cecilia Linde,
By the discussant- Cecilia Linde, MD,PhD, FESC, Dpt of Cardioogy, Karolinska University Hospital, Stockholm, Sweden. With the present eligibility criteria using wide QRS to establish ventricular dyssynchrony, only 60-70% of patients respond to CRT. Previous trials have demonstrated a good agreement between a single or a set of measures of MD and response to cardiac resynchronisation therapy. The PROSPECT (Predictors of response to CRT) study evaluated if a set of single MD criteria on top of wide QRS width increased the clinical and echocardiographic response to CRT in a multicentre non-randomised study of 426 heart failure patients with a classical indication for CRT including a QRS > 130 ms. MD and response to CRT was assessed at baseline and after 6 months of CRT. Each enrolling centre was trained on image acquisition and the echo-protocol and all echo assessments were performed in core labs. The patient characteristics in PROSPECT were similar to classical CRT recipients and clinical and echocardiographic response to CRT were in agreement with previous CRT trials. The yield for echo measures varied between 50 – 92 %, the inter core lab variability was relatively great (6.5-72.1%) in view of the expertise of the included centres, indicating the need for further simplification of methodology. Presence of MD was linked to a 11-13% additional clinical response rate to CRT and 13-23 % additional response for reverse remodelling compared compared absence of MD.
In this first attempt in a multi-centre study to establish the value of adding MD criteria to QRS no single MD measurement was reliable and ready for widespread use in the selection of candidates for CRT. Further elaboration of MD criteria is needed. Determination of MD should remain a part of the assessment of a patient considered for CRT. At present, QRS width remains as the ventricular dyssynchrony criterium to identify heart failure patients suitable for CRT.
© 2017 European Society of Cardiology. All rights reserved