Skip to main content

Advertisement

SpringerLink
Log in

Profiling cardiac resynchronization therapy patients: responders, non-responders and those who cannot respond—The good, the bad and the ugly?

  • Review
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Cardiac resynchronization therapy (CRT) is an effective option for the management of heart failure (HF) patients with left ventricular systolic dysfunction and prolongation of the QRS interval. Unfortunately, a variable proportion of eligible patients fail to benefit from this treatment, the so-called “non-responders”. Despite intensive investigations aimed at identifying reliable diagnostic tools, additional to standard criteria, for the selection of responders, partly due to the complexity and multi-factorial nature of the mechanism underlying response, no conclusive evidence is currently available about which of the many variables assessed may predict individual response and should be included in selection criteria. Accordingly, even if labeled as a non-responder, a patient should receive a CRT device being the certain risk of withholding the treatment more consistent than the potential risk of being a non-responder. However, a possible third profile of patients along with responders and non-responders is emerging consisting of a limited subset of individuals, mainly among those with HF of ischemic aetiology, who simply do not possess the anatomical requisite for conventional biventricular pacing to be effective. Such patients may be referred to as those who cannot respond to CRT and their identification is potentially feasible by integrating non-invasive imaging findings and of clinical relevance in the definition of the therapeutic strategy. In conclusion, this review will provide an analysis of gathered data about the selection of candidates to CRT beyond responders and non-responders with the perspective of the potential characterization of patients who cannot respond to CRT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Task Force for Diagnosis, Treatment of Acute, Chronic Heart Failure of European Society of Cardiology, Dickstein K, Cohen-Solal A, Filippatos G et al (2008) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the task force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 29:2388–2442

    Article  CAS  PubMed  Google Scholar 

  2. Jessup M, Abraham WT, Casey DE, et al. writing on behalf of the 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult Writing Committee (2009) 2009 Focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 119:1977–2016

    Google Scholar 

  3. Vardas PE, Auricchio A, Blanc JJ, European Society of Cardiology; European Heart Rhythm Association et al (2007) Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European society of Cardiology. Developed in collaboration with the European Heart Rhythm Association. Eur Heart J 28:2256–2295

    Article  PubMed  Google Scholar 

  4. McAlister FA, Ezekowitz J, Hooton N et al (2007) Cardiac resynchronization therapy for patients with left ventricular systolic dysfunction: a systematic review. JAMA 297:2502–2514

    Article  CAS  PubMed  Google Scholar 

  5. Ypenburg C, Westenberg JJ, Bleeker GB et al (2008) Noninvasive imaging in cardiac resynchronization therapy–part 1: selection of patients. Pacing Clin Electrophysiol 31:1475–1499

    Article  PubMed  Google Scholar 

  6. Stewart S, MacIntyre K, Capewell S, McMurray JJ (2003) Heart failure and the aging population: an increasing burden in the 21st century? Heart 89:49–53

    Article  CAS  PubMed  Google Scholar 

  7. McAlister FA, Tu JV, Newman A et al (2006) How many patients with heart failure are eligible for cardiac resynchronization? insights from two prospective cohorts. Eur Heart J 27:323–329

    Article  PubMed  Google Scholar 

  8. Auricchio A, Stellbrink C, Block M, The Pacing Therapies for Congestive Heart Failure Study Group, The Guidant Congestive Heart Failure Research Group et al (1999) Effect of pacing chamber and atrioventricular delay on acute systolic function of paced patients with congestive heart failure. Circulation 99:2993–3001

    CAS  PubMed  Google Scholar 

  9. Zhang Q, Fung JW, Auricchio A et al (2006) Differential change in left ventricular mass and regional wall thickness after cardiac resynchronization therapy for heart failure. Eur Heart J 27:1423–1430

    Article  PubMed  Google Scholar 

  10. Prinzen FW, Auricchio A (2008) Is echocardiographic assessment of dyssynchrony useful to select candidates for cardiac resynchronization therapy? echocardiography is not useful before cardiac resynchronization therapy if QRS duration is available. Circ Cardiovasc Imaging 1:70–77

    Article  PubMed  Google Scholar 

  11. Auricchio A, Prinzen FW (2008) Update on the pathophysiological basics of cardiac resynchronization therapy. Europace 10:797–800

    Article  PubMed  Google Scholar 

  12. Kass DA (2008) An epidemic of dissynchrony: but what does it mean? J Am Coll Cardiol 51:12–17

    Article  PubMed  Google Scholar 

  13. Bleeker GB, Schalij MJ, Molhoek SG et al (2004) Relationship between QRS duration and left ventricular dyssynchrony in patients with end-stage heart failure. J Cardiovasc Electrophysiol 15:544–549

    Article  PubMed  Google Scholar 

  14. Ghio S, Constantin C, Klersy C et al (2004) Interventricular and intraventricular dyssynchrony are common in heart failure patients, regardless of QRS duration. Eur Heart J 25:571–578

    Article  PubMed  Google Scholar 

  15. Galderisi M, Cattaneo F, Mondillo S (2007) Doppler echocardiography and myocardial dyssynchrony: a practical update of old and new ultrasound technologies. Cardiovasc Ultrasound 5:28

    Article  PubMed  Google Scholar 

  16. Anderson LJ, Miyazaki C, Sutherland GR, Oh JK (2008) Patient selection and echocardiographic assessment of dyssynchrony in cardiac resynchronization therapy. Circulation 117:2009–2023

    Article  PubMed  Google Scholar 

  17. Chung ES, Leon AR, Tavazzi L et al (2008) Results of the predictors of response to CRT (PROSPECT) trial. Circulation 117:2608–2616

    Article  PubMed  Google Scholar 

  18. van Bommel RJ, Bax JJ, Abraham WT et al (2009) Characteristics of heart failure patients associated with good and poor response to cardiac resynchronization therapy: a PROSPECT (predictors of response to CRT) sub-analysis. Eur Heart J 30:2470–2477

    Article  PubMed  Google Scholar 

  19. Karamitsos TD, Francis JM, Myerson S, Selvanayagam JB, Neubauer S (2009) The role of cardiovascular magnetic resonance imaging in heart failure. J Am Coll Cardiol 54:1407–1424

    Article  PubMed  Google Scholar 

  20. Van de Veire NR, Delgado V, Schuijf JD, van der Wall EE, Schalij MJ, Bax JJ (2009) The role of non-invasive imaging in patient selection. Europace 11(Suppl 5):v32–v39

    Article  PubMed  Google Scholar 

  21. Chen J, Bax JJ, Henneman MM, Boogers MJ, Garcia EV (2008) Is nuclear imaging a viable alternative technique to assess dyssynchrony? Europace 10(Suppl 3):iii101–iii105

    Article  PubMed  Google Scholar 

  22. Chen J, Henneman MM, Trimble MA et al (2008) Assessment of left ventricular mechanical dyssynchrony by phase analysis of ECG-gated SPECT myocardial perfusion imaging. J Nucl Cardiol 15:127–136

    Article  PubMed  Google Scholar 

  23. Gorcsan J III, Abraham T, Agler DA, American Society of Echocardiography Dyssynchrony Writing Group et al (2008) Echocardiography for cardiac resynchronization therapy: recommendations for performance and reporting: a report from the American Society of Echocardiography Dyssynchrony Writing Group endorsed by the Heart Rhythm Society. J Am Soc Echocardiogr 21:191–213

    Article  PubMed  Google Scholar 

  24. Ciampi Q, Pratali L, Citro R, Piacenti M, Villari B, Picano E (2009) Identification of responders to cardiac resynchronization therapy by contractile reserve during stress echocardiography. Eur J Heart Fail 11:489–496

    Article  PubMed  Google Scholar 

  25. Bleeker GB, Kaandorp TA, Lamb HJ et al (2006) Effect of posterolateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy. Circulation 113:969–976

    Article  PubMed  Google Scholar 

  26. Ypenburg C, Schalij MJ, Bleeker GB et al (2007) Impact of viability and scar tissue on response to cardiac resynchronization therapy in ischaemic heart failure patients. Eur Heart J 28:33–41

    Article  PubMed  Google Scholar 

  27. Van de Veire NR, Schuijf JD, De Sutter J et al (2006) Non-invasive visualization of the cardiac venous system in coronary artery disease patients using 64-slice computed tomography. J Am Coll Cardiol 48:1832–1838

    Article  PubMed  Google Scholar 

  28. Chiribiri A, Kelle S, Götze S et al (2008) Visualization of the cardiac venous system using cardiac magnetic resonance. Am J Cardiol 101:407–412

    Article  PubMed  Google Scholar 

  29. Auricchio A, Sorgente A, Singh JP et al (2007) Role of multislice computed tomography for preprocedural evaluation before revision of a chronically implanted transvenous left ventricular lead. Am J Cardiol 100:1566–1570

    Article  PubMed  Google Scholar 

  30. Goitein O, Lacomis JM, Gorcsan J III, Schwartzman D (2006) Left ventricular pacing lead implantation: potential utility of multimodal image integration. Heart Rhythm 3:91–94

    Article  PubMed  Google Scholar 

  31. Van de Veire NR, Marsan NA, Schuijf JD et al (2008) Noninvasive imaging of cardiac venous anatomy with 64-slice multi-slice computed tomography and noninvasive assessment of left ventricular dyssynchrony by 3-dimensional tissue synchronization imaging in patients with heart failure scheduled for cardiac resynchronization therapy. Am J Cardiol 101:1023–1029

    Article  PubMed  Google Scholar 

  32. Cleland JG, Tavazzi L, Daubert JC, Tageldien A, Freemantle N (2009) Cardiac resynchronization therapy: are modern myths preventing appropriate use? J Am Coll Cardiol 53:608–611

    Article  PubMed  Google Scholar 

  33. Sciagrà R, Giaccardi M, Porciani MC et al (2004) Myocardial perfusion imaging using gated SPECT in heart failure patients undergoing cardiac resynchronization therapy. J Nucl Med 45:164–168

    PubMed  Google Scholar 

  34. Marsan NA, Bleeker GB, Van Bommel RJ et al (2009) Cardiac resynchronization therapy in patients with ischemic versus non-ischemic heart failure: differential effect of optimizing interventricular pacing interval. Am Heart J 158:769–776

    Article  PubMed  Google Scholar 

  35. Regoli F, Auricchio A (2009) The role of invasive mapping in the electrophysiology laboratory. Europace 11(Suppl 5):v40–v45

    Article  PubMed  Google Scholar 

  36. Pratola C, Notarstefano P, Toselli T, et al (2009) Noncontact mapping of left ventricle during CRT implant. Pacing Clin Electrophysiol [Epub ahead of print]

  37. van Deursen C, van Geldorp IE, Rademakers LM et al (2009) Left ventricular endocardial pacing improves resynchronization therapy in canine left bundle-branch hearts. Circ Arrhythm Electrophysiol 2:580–587

    Article  PubMed  Google Scholar 

Download references

Conflict of interest statement

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Cardiology, Cardiovascular and Thoracic Department, Santa Maria alle Scotte Hospital, Viale Bracci 16, 53100, Siena, Italy

    Valerio Zacà, Rosaria Gaddi & Roberto Favilli

  2. Postgraduate School of Cardiology, Department of Cardiovascular Disease, University of Siena, Siena, Italy

    Sergio Mondillo

Authors
  1. Valerio Zacà
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sergio Mondillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rosaria Gaddi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roberto Favilli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Valerio Zacà.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zacà, V., Mondillo, S., Gaddi, R. et al. Profiling cardiac resynchronization therapy patients: responders, non-responders and those who cannot respond—The good, the bad and the ugly? . Int J Cardiovasc Imaging 27, 51–57 (2011). https://doi.org/10.1007/s10554-010-9651-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-010-9651-y

Keywords

Search

Navigation