The Role of Echocardiography in the Optimization of Cardiac Resynchronization Therapy: Current Evidence and Future Perspectives

Michael Spartalis1, *, Eleni Tzatzaki1, Eleftherios Spartalis2, Christos Damaskos2, Antonios Athanasiou3, Efthimios Livanis1, Vassilis Voudris1
1 Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
2 Laboratory of Experimental Surgery and Surgical Research, University of Athens, Medical School, Athens, Greece
3 Department of Surgery, Mercy University Hospital, Cork, Ireland

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Creative Commons License
© 2017 Spartalis et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece, Tel: +306937291476; Fax: +302107488979; E-mail:



Cardiac resynchronization therapy (CRT) has become a mainstay in the management of heart failure. Up to one-third of patients who received resynchronization devices do not experience the full benefits of CRT. The clinical factors influencing the likelihood to respond to the therapy are wide QRS complex, left bundle branch block, female gender, non-ischaemic cardiomyopathy (highest responders), male gender, ischaemic cardiomyopathy (moderate responders) and narrow QRS complex, non-left bundle branch block (lowest, non-responders).


This review provides a conceptual description of the role of echocardiography in the optimization of CRT.


A literature survey was performed using PubMed database search to gather information regarding CRT and echocardiography.


A total of 70 studies met selection criteria for inclusion in the review. Echocardiography helps in the initial selection of the patients with dyssynchrony, which will benefit the most from optimal biventricular pacing and provides a guide to left ventricular (LV) lead placement during implantation. Different echocardiographic parameters have shown promise and can offer the possibility of patient selection, response prediction, lead placement optimization strategies and optimization of device configurations.


LV ejection fraction along with specific electrocardiographic criteria remains the cornerstone of CRT patient selection. Echocardiography is a non-invasive, cost-effective, highly reproducible method with certain limitations and accuracy that is affected by measurement errors. Echocardiography can assist with the identification of the appropriate electromechanical substrate of CRT response and LV lead placement. The targeted approach can improve the haemodynamic response, as also the patient-specific parameters estimation.

Keywords: Echocardiography, Resynchronization, CRT, Dyssynchrony, Optimization.