AIM: To determine if incorporation of assessment of mechanical dyssynchrony could improve the prognostic value of patient selection based on current guidelines. METHODS AND RESULTS: Echocardiography was performed in 1060 patients before and 12 ± 6 months after cardiac resynchronization therapy (CRT) implantation. Mechanical dyssynchrony, defined as the presence of apical rocking or septal flash was visually assessed at the baseline examination. Response was defined as ≥15% reduction in left ventricular end-systolic volume at follow-up. Patients were followed for a median of 59 months (interquartile range 37-86 months) for the occurrence of death of any cause. Applying the latest European guidelines retrospectively, 63.4% of the patients had been implanted with a Class I recommendation, 18.2% with Class IIa, 9.4% with Class IIb, and in 9% no clear therapy recommendation was present. Response rates were 65% in Class I, 50% in IIa, 38% in IIb patients, and 40% in patients without a clear guideline-based recommendation. Assessment of mechanical dyssynchrony improved response rates to 77% in Class I, 75% in IIa, 62% in IIb, and 69% in patients without a guideline-based recommendation. Non-significant difference in survival among guideline recommendation classes was found (Log-rank P = 0.2). Presence of mechanical dyssynchrony predicted long-term outcome better than guideline Classes I, IIa, IIb (Log-rank P < 0.0001, 0.006, 0.004, respectively) and in patients with no guideline recommendation (P = 0.02). Comparable results were observed using the latest American Guidelines. CONCLUSION: Our data suggest that current guideline criteria for CRT candidate selection could be improved by incorporating assessment of mechanical asynchrony.

Cardiovascular Center Aalst OLV Clinic Aalst Belgium

Department of Cardiology Clinical Hospital Centre Zemun Faculty of Medicine University of Belgrade Belgrade Serbia

Department of Cardiology Congenital Heart Diseases and Electrotherapy Silesian Center for Heart Diseases Silesian University of Medicine Silesia Poland

Department of Cardiology Heart and Diabetes Centre of North Rhine Westphalia Ruhr University Bochum Bad Oeynhausen Germany

Department of Cardiology Institute for Clinical and Experimental Medicine Prague Czech Republic

Department of Cardiology Oslo University Hospital Oslo Norway

Department of Cardiovascular Diseases Faculty of Medicine Suez Canal University km 4 5 Ring road Ismailia Egypt

Department of Cardiovascular Diseases University Hospitals Leuven University of Leuven Herestraat 49 Leuven Belgium

Department of Circulation and Imaging Faculty of Medicine NTNU Norwegian University of Science and Technology and Clinic of Cardiology St Olavs Hospital Trondheim Norway

Department of Internal Medicine and Gastroenterology Clinical Emergency Hospital University of Medicine and Pharmacy 'Carol Davila' Bucharest Romania

Klinik für Innere Medizin und Kardiologie St Vinzenz Hospital Cologne Germany

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