Cardiac resynchronization therapy (CRT) reduces mortality and morbidity in selected patients with heart failure (HF); however approximately one third of the implanted patients do not show any benefit from this treatment [1,2]. Thus a number of devices are implanted without any recognized clinical benefit; this has important implications for health costs, as well as exposing patients to unnecessary risks [10].Indication to this treatment is still based mainly on electric parameters [3-9] . In order to evaluate any predictors of outcome, the left ventricle has been...

Patients population: We retrospectively enrolled 39 consecutive patients (15F, 24M, mean age 59±11 years, NYHA class II-IV) with a diagnosis of DCM, ejection fraction (EF) 25 ±5%, left bundle branch block (LBBB) and QRS length 150 ±23ms, who had a complete cardiovascular evaluation including clinical examination, blood parameters, ECG, echocardiography and CMR with assessment of the RV morphology and function (Fig. 1). All patients were treated with optimal medical therapy for at least 3 months (ßb 85%, ACEI/ ATIIA 90%, furosemide 92%, AA 67%).We excluded...

At a mean follow up of 38 ±18 months twenty patients (51%) were considered responders, while nineteen (49%) did not show any echocardiographic benefit, although 5 of them (26%) had an improvement of 1 NYHA functional class (Fig. 5). No one of the LV parameters such as LVEF, ESV and EDV showed a prognostic value. Non-responders had a significant lower RVEF compared to responders (44±16% vs 57±10%; p=0,014) (Fig. 6), higher end systolic volume (83 ±40 ml vs 53 ±25ml; p=0,032) (Fig. 7) and a...

Our study demonstrates how systolic RV dysfunction can predict a worse outcome in patients treated with CRT although it should be validated in a larger cohort of patients. A careful examination of the RV before the implant can stratify patients who will probably benefit from the implant.

Stefano Cossa, MD Radiology Unit - AOBrotzu, Cagliari/Italy Paolo Manca, MD Cardiology Dep. - University of Cagliari, Monserrato/Italy Gildo Matta, MD, Radiology Unit - AOBrotzu, Cagliari/Italy Marco Corda, MD Cardiology Department - AOBrotzu, Cagliari/Italy Grazia T Bitti, MD Radiology Unit - AOBrotzu, Cagliari/Italy Maurizio Porcu; MDCardiology Department - AOBrotzu, Cagliari/Italy

Maximo Rivero-Aierza, Dominic A.M.J. Theuns, Hector M. Garcia-Garcia, Eric Boersma, Maarten Simoons, Luc J. Jordaens: Effects of cardiac resynchronization therapy on overall mortality and mode of death: a meta-analysis of randomized controlled trials. European Heart Journal 2006, 27:2682-2688. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L: Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005, 352:1539-1549. Kindermann M, Mahfoud F, Ukena C, Fröhlig G. Cardiac...