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Cardiac-Resynchronization Therapy in Heart Failure with Narrow QRS Complexes

Cardiac-Resynchronization Therapy in Heart Failure with Narrow QRS Complexes,10.1056/NEJMoa0706695,New England Journal of Medicine,John F. Beshai,Rich

Cardiac-Resynchronization Therapy in Heart Failure with Narrow QRS Complexes   (Citations: 199)
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Journal: New England Journal of Medicine - N ENGL J MED , vol. 357, no. 24, pp. 2461-2471, 2007
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    • ...The large RETHINQ study failed to show benefit in patients with a QRS duration ≤130 ms (although subgroup analysis of patients with a QRS duration of 120–130 ms suggested a possible benefit) [29]...

    John Rickardet al. Pivotal trials of cardiac resynchronization therapy: evolution to ther...

    • ...After initial results in single center studies were met by enthusiasm, disillusion and criticism followed because in multicenter trials echocardiography hardly improved the prediction of response to CRT [17, 18]...
    • ...Inversely the RethinQ-trial has demonstrated very low IVMD values in patients with narrow QRS and accordingly poor response [18]...
    • ...The incremental value of such locally derived markers over the conventional method, and of local inter- over intraventricular temporal delays, remains disputed [17, 18, 28, 30, 43]...
    • ...To date, motionand velocity-based methods are also the only regional dyssynchrony markers tested and evaluated in multicenter trials [17, 18, 44]...
    • ...On the assumption that timing of systolic motion and/or velocity in the investigated segment reflects the mechanical activity of the underlying myocardium, TDI and other motion-based methods have not only been proposed to investigate the presence of dyssynchrony but also to detect the site of latest activation or to screen for dyssynchrony in failing hearts with narrow QRS [18, 60]...
    • ...These confounders at least partially explain the high incidence of dyssynchrony in failing hearts without conduction delays reported by these techniques, and the disappointing predictive performance in a number of more recent large studies [17, 18, 48, 59, 64, 65]...
    • ...Although single center studies have suggested echocardiography as an additional screening to extend the application of CRT to patients with narrow-QRS heart failure, this could not be confirmed in a large prospective study [18, 98]...

    Geert E. LeendersMaartenet al. Echocardiographic prediction of outcome after cardiac resynchronizatio...

    • ...The effect of cardiac resynchronisation therapy (CRT) in patients with heart failure without left bundle branch block (LBBB) is disputable [1]...
    • ...In a randomised trial, CRT also failed to improve quality of life and functional and echocardiographic parameters in heart failure patients with QRS <130 ms and mechanical dyssynchrony [1]...

    M. D. Bogaardet al. Haemodynamic Benefit of Cardiac Resynchronisation Therapy Requires Lef...

    • ...Efforts to develop mechanical dyssynchrony techniques based on imaging modalities have been disappointing when applied in widespread clinical settings [15, 16]...
    • ...The ACC/AHA/HRS guidelines for device-based therapy therefore do not advocate CRT as a ‘‘rescue therapy’’ in this population [15]...

    Norman C. Wanget al. The potential role of cardiac resynchronization therapy in acute heart...

    • ...Two prospectively designed, yet moderately large, studies in patients with advanced HF and normal QRS complex have been completed, the ReThinQ [34] and ESTEEM-CRT [35] trials; both studies missed the primary endpoint and turned out to be negative...

    Angelo Auricchioet al. Past, present, and future of CRT

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