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What CRT Registry Studies Have Told Us?

      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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