Beoordeling van Mechanische Dyssynchronie als Selectiecriterium voor Cardiale Resynchronisatie Therapie

Cardiac Resynchronization Therapy (CRT) is a widely accepted treatment for patients suffering from heart failure associated with conduction delays. CRT consists of a dedicated pacemaker device, re-synchronizing the timing of contraction of the left ventricular chamber. However, the current eligibility criteria for CRT therapy result in a non-responder rate of approximately 35%. Considering the cost and the risk associated with CRT, several eligibility criteria using echocardiography have been suggested over the past decade, aiming to reduce the high non-responder rate, all of which were based on timing of myocardial velocity peaks. Unfortunately, these echocardiographic criteria failed to demonstrate added value in randomized, multicenter studies presumably due to their limited reproducibility and poor specificity. In contrast, our research group investigated new echocardiographic criteria specific to the dyssynchronous motion pattern caused by the conduction delay, i.e. apical rocking and septal flash. Several retrospective studies, including a large multicenter analysis, suggests the presence of these patterns is strongly associated with therapy success and has a stronger predictive value than current guideline criteria. We therefore propose a multicenter, prospective, randomized study to test these patterns as new eligibility criteria for CRT versus current guideline criteria. Our goal is to provide strong evidence to change current treatment recommendations resulting in reduced non-responder rate and improved patient management and outcome.