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Is there a role for imaging techniques in cardiac resynchronization therapy?

Dr. I. Stankovic, Department of Cardiology, Clinical Hospital Centre Zemun and Faculty of Medicine, University of Belgrade, Serbia  



“I would say that, right now, there is a hope that there will be a role for cardiac imaging in cardiac resynchronization therapy (CRT) in the near future and, thankfully, there is ongoing research.

In the beginning, we were overly enthusiastic but this was dampened by disappointing results from two major trials. I would say that, now, we are cautiously optimistic and it’s great to see that there is ongoing research, some presented at EuroEcho–Imaging 2016.

This is great because people were disappointed about the results of the PROSPECT trial in 2009,1 which indicated that there were no echocardiographic parameters that could help improve patient selection for CRT. There was subsequently a huge decline in publications on the topic. This was followed in 2013 by the EchoCRT trial,2 which showed that CRT was not beneficial in heart failure with a narrow QRS complex and may even increase mortality.

Since then, the whole concept has changed and novel parameters have emerged. What we need now is some hard evidence from new randomized trials to support these parameters. However, many people think that it would be an adventure to undertake such trials, and no-one is daring to start.

In terms of imaging techniques, echocardiography is, for me, number one for patient selection and, possibly, optimization in CRT. Magnetic resonance imaging should be used for assessing extent of myocardial scar. While nuclear techniques may be useful, they involve exposure to radiation.”

References

  1. Chung ES, Leon AR, Tavazzi L et al. Results of the Predictors of Response to CRT (PROSPECT) trial. Circulation 2008; 117: 2608– 2616.
  2. Ruschitzka F, Abraham WT, Singh JP et al. Cardiac-resynchronization therapy in heart failure with a narrow QRS complex. N Engl J Med 2013; 369: 1395–1405.