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Role of mechanical dyssynchrony in cardiac resynchronisation therapy candidates

Non-Invasive Imaging

This session was an excellent compilation of lectures by experts in myocardial mechanics and dyssynchrony. In a stimulating discussion with the audience, major aspects of this controversial field of research were highlighted.

In the first talk, Dr. Joost Lummens (Maastricht, NL) discussed the influence of contractility, stiffness, mechanical delay and remodelling of the heart using a self-developed computer-model (“CircAdapt”, freely available at which makes it possible to control these parameters independently. Despite a high degree of abstraction, this model resembles very well and, thus, helps to better understand the typical motion patterns of the heart walls occurring in patients with conduction delay and/or regional dysfunction.

In the second talk, Dr. John Gorcsan IIIrd (Pittsburgh, US), explained the importance of measuring regional myocardial deformation for the assessment of mechanical dyssynchrony. For this, his lab favours temporal delays in radial strain acquired from an echocardiographic parasternal short axis view.

The third speaker, Dr. Otto Smiseth (Oslo, NO) discussed interactions between regional remodelling, dysfunction and loading and its influence on regional myocardial work. A “wasted energy index” was suggested and shown to be a marker of treatable mechanical dyssynchrony. The same can be assumed when septal beaking or apical rocking is observed.

The last speaker, Ivan Stankovic (Belgrade, RS) presented an impressive study investigating apical rocking and septal flash as easy-to-use clinical markers for the prediction of CRT success in 1071 patients. Both echocardiographic parameters can predict response to CRT and are strongly associated with favourable outcome 5 years after CRT implantation.




Role of mechanical dyssynchrony in cardiac resynchronisation therapy candidates

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.