In the early 2000s, echocardiography was identified as an ideal modality to predict
cardiac resynchronization therapy (CRT) responders and various single center studies
showed good results. However, PROSPECT study, prospective multi-center study, showed
disappointing results. Poor reproducibility of parameters and various biases seemed
to be essential problems. START study was a multicenter prospective cohort study of
patients undergoing CRT in Japan since 2009 for two years to identify the feasibility
of speckle tracking echocardiography. The objectivity of the data was strictly assessed.
The standard deviation of time to the first peak circumferential strain >116 ms was
selected as the best independent predictor of CRT responders in addition to left bundle
branch block, blood urea nitrogen, β-blocker and mitral regurgitation. The interinstitutional
reproducibility was excellent. Left ventricular ejection fraction has been still an
only imaging parameter included in current guidelines on CRT. To establish the usefulness
of imaging on CRT, we need to assure the objectivity and reproducibility of parameters
and recognize the influence of various factors.
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