ECHO is not raccomended in the guidelines for CRT selection, but in many centers still has a role especially in borderline situations
The only roles for echo in selecting CRT are to assess LV ejection fraction and lateral wall function/ viability. No trials have shown any benefit or agreement in echo guidance of CRT parameters.
We use echocardiography only to determine LV function and do not check dyssynchrony parameters to qualify patient to CRT.
Echo is the cheepest tool to assess EF%. and without knowing that the EF150msec) and then you jump for Cardiac MRI for furture evaluation of (TM myocardial Scar + CS anatomy + Dyssynchrony ?
Only to evaluate the EF. We evaluate dissynchrony by GATED.
Until last week I would have stated in narrow complex and right bundle branch block patients, but with the presentation of ECHO-AF we need to question even this. It comes down to whether CRT as performed today is a treatment for complex Dyssynchrony ( by whatever definition) or for late activation of the lateral wall associated with LBBB. It now looks as if this is the answer until delivery systems can become more anatomically targeted.
I use 3D Echo to evaluate EF and dyssynchrony. SDI can give us the probability of response to CRT even when the decision is based on clinical and EKG.
As of now ,in my practice I follow the guideline of LBBB as an indicator of dysynchrony.Of course I use 2D echo to determine EF
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