Assessment of Mechanical Dyssynchrony as Selection Criterion for CRT Treatment (CRT TREATMENT)

Cardiac resynchronization therapy is an accepted treatment for patients with heart failure and conduction delays, where the contraction of the left ventricular chamber is re-synchronized by means of a dedicated pacemaker device with several electrodes. Current guideline criteria for selecting patients, however, result in a non-responder rate of approximately 35%. Some studies suggest that such non-responders are even at higher risk because of an inappropriate treatment. In the past years, the promotor of this project has worked on the characterization of specific motion and deformation patterns of the left ventricle in patient candidates for CRT by echocardiography. We could demonstrate with several retrospectives studies, including also a multicenter analysis of more than 1000 patients after CRT implantation, that the presence of specific motion and deformation patterns (apical rocking, septal flash) is strongly associated with therapy success and that the predictive value of the patterns is much higher than that of current guideline criteria. We therefore propose a prospective, randomized study to test these patterns as patient selection criterion for CRT in comparison to current guideline criteria in order to provide strong evidence that can influence treatment recommendation of scientific societies and with this, improve patient management and outcome. In Belgium, ca 1500 CRT devices are implanted per year with costs for the health care system of ca. 23 million Euro. Given the high non-responder rate, devices worth 8 million Euro are implanted without effect. Even if all unnecessary CRT+Defibrillator implantations were replaced by a regular implantable defibrillator (ICD), approximately 2.1 million Euro could be saved with better patient selection. If our propose approach would help to reduce the non-responder rate only by 50%, a yearly cost-benefit of more than 1 Million Euro could be achieved.