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Imaging Cardiac Resynchronization Therapy

Theodore Abraham, MD^_*, David Kass, MD^_*, Giovanni Tonti, MD, Gery F. Tomassoni, MD, William T. Abraham, MD, Jeroen J. Bax, MD^||, Thomas H. Marwick, MBBS, PhD^¶,_*

^_* Johns Hopkins Medical Institutions, Baltimore, Maryland
Catholic University of Sacred Heart of Campobasso, Campobasso, Italy
Lexington Cardiology Consultants, Lexington, Kentucky
Ohio State University, Columbus, Ohio
^|| Leiden University, Leiden, the Netherlands
^¶ University of Queensland, Brisbane, Australia

^_* Reprint requests and correspondence: Dr. Thomas H. Marwick, University of Queensland School of Medicine, Princess Alexandra Hospital, Ipswich Road, Brisbane, Qld 4102, Australia (Email: t.marwick{at}uq.edu.au).

Although a prognostic benefit has been shown from cardiac resynchronization therapy, questions are often directed toward the prediction of symptomatic or functional benefit. Recent multicenter trials have shown the pitfalls of current mechanical markers of left ventricular synchrony, but these negative trial results have not marked the conclusion of efforts to predict outcome. Potential new contributors to the assessment of mechanical synchrony include echocardiographic and magnetic resonance techniques for the assessment of myocardial deformation. Nonsynchrony markers that seem promising include assessment of the location and extent of myocardial scar and imaging of the coronary venous and phrenic nerve anatomy.

Key Words: heart failure • synchrony • LV dysfunction • echocardiography • cardiac magnetic resonance • computed tomography

Abbreviations and Acronyms   2D = 2-dimensional   3D = 3-dimensional   CMR = cardiac magnetic resonance   CRT = cardiac resynchronization therapy   CS = coronary sinus   ICE = intracardiac echocardiography   LV = left ventricle/ventricular   RV = right ventricle/ventricular   TDE = tissue Doppler echocardiography

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