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Echocardiography in CRT Patient Selection Controversial

Last Updated: May 22, 2009.

Research should continue into the use of echocardiography as a means to select candidates for implant of cardiac resynchronization therapy devices, but QRS prolongation remains the recommended criterion in making that decision. That was the apparent consensus of a trio of papers arguing the question in the May 26 issue of the Journal of the American College of Cardiology.

FRIDAY, May 22 (HealthDay News) -- Research should continue into the use of echocardiography as a means to select candidates for implant of cardiac resynchronization therapy (CRT) devices, but QRS prolongation remains the recommended criterion in making that decision. That was the apparent consensus of a trio of papers arguing the question in the May 26 issue of the Journal of the American College of Cardiology.

In one paper, Jeroen J. Bax, M.D., of Leiden University Medical Centre in the Netherlands and John Gorcsan III, M.D., of the University of Pittsburgh Medical Center, reviewed evidence regarding echocardiographic measures that can predict a response to CRT and write that refinements in data acquisition and analysis and better understanding of pathophysiology will continue to improve the CRT selection process. In another paper, Nathaniel M. Hawkins, of the University Hospital Aintree in Liverpool, United Kingdom, concludes that QRS prolongation has demonstrated efficacy as a means to identify patients for CRT device implant in trials enrolling more than 4,000 patients, and the approach is still recommended in international guidelines.

In a counterpoint, John E. Sanderson, M.D., of the University of Birmingham in the United Kingdom concedes that echocardiography has become controversial with the results of the Predictors of Response to CRT trial. However, Sanderson argues that some patients receiving CRT devices do worse rather than better, indicating the current selection process relying on QRS prolongation needs to be improved.

"New large trials are required to properly test this more targeted approach. This will mean progress for our patients and a more intelligent use of limited medical resources. Unreasonable exhortations to follow current guidelines should not be allowed to stifle developments that may refine those same guidelines for the overall benefit of our patients and society," Sanderson concludes.

Full Text - Bax & Gorcsan (subscription may be required)
Abstract - Hawkins
Full Text - Hawkins (subscription may be required)
Editorial - Sanderson (subscription may be required)


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