Copyright © 2004 by the European Society of Cardiology.
Letter to the Editor
Tissue Doppler and cardiac resynchronisation therapy: a new challenge for the optimal choice of candidates: Reply
Divisione di Cardiologia Policlinico S Matteo Piazza Golgi 1, 27100 Pavia, Italy
* Corresponding author. Tel.: +39-382503713; fax: +39-382503159
E-mail address: s.ghio{at}smatteo.pv.it
Dear Editor,
The identification of responders to cardiac resynchronisation therapy (CRT) is a major clinical issue.1 Many researchers have focused their attention to the identification of echocardiographic parameters which may be predictive of responsiveness.2–6 However, we still lack comparative data and do not know which is the most useful parameter; in particular we do not know whether new, but not widespread, technology such as tissue Doppler imaging really offers substantial advantage over more simple M-Mode or pulsed Doppler parameters. Ongoing trials will give us the answer. At the same time, research is necessary to address many unsolved pathophysiological issues particularly in the field of electro-mechanical coupling. CRT is emerging as a recommended therapy for patients with heart failure and dyssynchrony, but pathophysiology of dyssynchrony is far from being fully understood. This was, in fact, the area of interest of our work. Studying the prevalence of dyssynchrony in heart failure patients, evaluating the mechanical consequences of conduction disturbances and the relationship between inter and intraventricular dyssynchrony is obviously of no immediate help in the selection of candidates to CRT. However, we strongly believe that understanding dyssynchrony is, in the near future, one of the most important things we can do to improve treatments of our heart failure patients.
References
- Tavazzi L. Ventricular pacing: a promising new therapeutic strategy in failure. For whom? Eur. Heart J. 2000;21:1246–1250.
[Abstract/Free Full Text] - Sogaard P, Egeblad H, Kim W et al. Tissue Doppler imaging predicts improved systolic performance and reverse left ventricular remodeling during long-term cardiac resynchronization therapy. J. Am. Coll. Cardiol. 2002;40:723–730.
[Abstract/Free Full Text] - Bax JJ, Malhoek SG, Marwick TH et al. Usefulness of myocardial tissue Doppler echocardiography to evaluate left ventricular dyssynchrony before and after biventricular pacing in patients with idiopatic dilated cardiomyopathy. Am. J. Cardiol. 2003;91:94–97.[CrossRef][ISI][Medline]
- Pitzalis MV, Iacoviello M, Romito R et al. Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony. JACC. 2002;40:1615–1622.
[Abstract/Free Full Text] - Cazeau S, Bordacher P, Jauvert A et al. Echocardiographic modeling of cardiac dyssynchrony before and during multisite stimulation. PACE. 2003;26:1–7.
- Yu CM, Fung WH, Lin H et al. Predictors of left ventricular reverse remodeling after ischemic cardiomyopathy. Am. J. Cardiol. 2002;91(6):684–688.
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