Search
Close
Search
Advanced Search
Search Menu
AI Discovery Assistant

Extract

This editorial refers to ‘Contractility sensor-guided optimization of cardiac resynchronization therapy: results from the RESPOND-CRT trial’†, by J. Brugada et al., on page 730.

Cardiac resynchronization therapy (CRT) is an electrical treatment based on biventricular or left ventricular (LV)-only pacing that was initially applied as a last-resort therapeutic solution for patients with severe heart failure (HF) associated with left bundle branch block. Despite the technical limitations of devices and leads in the first phases of clinical use, the clinical use of CRT rapidly moved from uncontrolled evaluations to randomized controlled trials (RCTs) that definitively validated its role in appropriately selected patients with NYHA II–IV heart failure.1–3 Moreover, the favourable outcome of appropriately selected patients implanted with a CRT device has been confirmed in ‘real-world’ studies and in evaluations focused on cost-effectiveness.4–6

As with any treatment, assessment of patient outcomes after CRT differs from assessment of the percentage of patients who can be classified as ‘responders’ on the basis of individual responses. A series of investigations reported that the proportion of responders to CRT is in the range of 57–67% among patients with moderate to severe HF.3,7 The attempts to improve the response to CRT, evaluated in terms of LV reverse remodelling, an endpoint used as a surrogate of outcome, has prompted a series of studies aimed at identifying the clinical, echocardiographic, and electrocardiographic profile of responders, identifying and quantifying LV dyssynchrony (by echo, magnetic resonance imaging, nuclear cardiology, etc.) and quantifying scar tissue (as a marker of ‘non-correctable’ dyssynchrony and for appropriate LV lead positioning), assessing the relationship between acute haemodynamic response and long-term response or outcome and assessing the impact of tailoring of atrioventricular (AV) and interventricular (VV) interval programming on indices of LV function, response to CRT, and patient outcome.1–3,7

Issue Section:
Clinical Research
You do not currently have access to this article.
Download all slides