Contractile Reserve in Dyssynchrony: A Novel Principle to Identify Candidates for Cardiac Resynchronization Therapy (CRID-CRT)
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Cardiac resynchronisation therapy (CRT) has been documented to be a powerful treatment in patients with severe congestive heart failure. However, 30-40% of patients receiving a CRT are non-responders. In this study the investigators will use a previously validated method to estimate myocardial segment work non-invasively by speckle-tracking echocardiography and blood pressure. Since segments which shorten in systole perform positive work, whereas segments which lengthen do negative work, the investigators will calculate wasted work as negative work in percentage of positive work. The main purpose of the study is to determine if wasted work can predict response to CRT.
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Layout table for eligibility information
Ages Eligible for Study:
18 Years and older (Adult, Older Adult)
Sexes Eligible for Study:
Accepts Healthy Volunteers:
Subjects who are indicated for CRT device according to European Society of Cardiology (ESC) guidelines (2013).
Subject is indicated for CRT device according to current European Society of Cardiology (ESC) guidelines (2013):
Before CRT is considered, the patient should receive guideline-directed optimal medical therapy for heart failure and LV function must be severely depressed (LVEF ≤35%). In addition the following criteria must be fulfilled:
NYHA functional class II, III or ambulatory IV and in stable sinus rhythm last two weeks.
ECG: Left Bundle Branch Block (LBBB) with QRS duration >120 ms and non-LBBB with QRS >150 ms.
Patient with conventional pacemaker in NYHA functional class III and ambulatory IV if high percentage of ventricular pacing.
Subject is willing to sign informed consent form and is 18 years or older.
Right bundle branch block.
Permanent atrial fibrillation
Recent myocardial infarction, within 40 days prior to enrollment.
Subject underwent coronary artery bypass graft (CABG) or valve surgery, within 90 days.
Post heart transplantation, or is actively listed on the transplantation list, or has reasonable probability (per investigator's discretion) of undergoing transplantation in the next year
Implanted with a LV assist device (LVAD), or has reasonable probability (per investigator's discretion) of receiving a LVAD in the next year
Severe aortic stenosis (with a valve area of <1.0 cm2 or significant valve disease expected to be operated on within study period).
Complex and uncorrected congenital heart disease.
Breastfeeding women or women of child bearing potential.
Enrolled in one or more concurrent studies that would confound the results of this study.
Impossible to obtain LV volumes by echocardiography