{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T04:36:14Z","timestamp":1780806974446,"version":"3.54.1"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2021,12,6]],"date-time":"2021-12-06T00:00:00Z","timestamp":1638748800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"COHFAR","award":["01C-203"],"award-info":[{"award-number":["01C-203"]}]},{"DOI":"10.13039\/501100002996","name":"Dutch Heart Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002996","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,11,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Judicious patient selection for cardiac resynchronization therapy (CRT) may further enhance treatment response. Progress has been made by using improved markers of electrical dyssynchrony and mechanical discoordination, using QRSAREA, and systolic rebound stretch of the septum (SRSsept) or systolic stretch index (SSI), respectively. To date, the relation between these measurements has not yet been investigated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>A total of 240 CRT patients were prospectively enrolled from six centres. Patients underwent standard 12-lead electrocardiography, and echocardiography, at baseline, 6-month, and 12-month follow-up. QRSAREA was derived using vectorcardiography, and SRSsept and SSI were measured using strain-analysis. Reverse remodelling was measured as the relative decrease in left ventricular end-systolic volume, indexed to body surface area (\u0394LVESVi). Sustained response was defined as \u226515% decrease in LVESVi, at both 6- and 12-month follow-up. QRSAREA and SRSsept were both strong, multivariable adjusted, variables associated with reverse remodelling. SRSsept was associated with response, but only in patients with QRSAREA \u2265 120 \u03bcVs (AUC = 0.727 vs. 0.443). Combined presence of SRSsept \u2265 2.5% and QRSAREA \u2265 120 \u03bcVs significantly increased reverse remodelling compared with high QRSAREA alone (\u0394LVESVi 38 \u00b1 21% vs. 22 \u00b1 21%). As a result, 92% of left bundle branch block (LBBB)-patients with combined electrical and mechanical dysfunction were \u2018sustained\u2019 volumetric responders, as opposed to 51% with high QRSAREA alone.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Parameters of mechanical dyssynchrony are better associated with response in the presence of a clear underlying electrical substrate. Combined presence of high SRSsept and QRSAREA, but not high QRSAREA alone, ensures a sustained response after CRT in LBBB patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjci\/jeab264","type":"journal-article","created":{"date-parts":[[2021,11,23]],"date-time":"2021-11-23T20:43:56Z","timestamp":1637700236000},"page":"1628-1635","source":"Crossref","is-referenced-by-count":9,"title":["Does mechanical dyssynchrony in addition to QRS area ensure sustained response to cardiac resynchronization therapy?"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3406-4083","authenticated-orcid":false,"given":"Philippe C","family":"Wouters","sequence":"first","affiliation":[{"name":"Department of Cardiology, University Medical Center Utrecht , Heidelberglaan 100, 3584 CX Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3577-8923","authenticated-orcid":false,"given":"Wouter M","family":"van Everdingen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Utrecht , Heidelberglaan 100, 3584 CX Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8818-5964","authenticated-orcid":false,"given":"Kevin","family":"Vernooy","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+) , 6229 HX Maastricht , The Netherlands"},{"name":"Department of Cardiology, Radboud University Medical Center , 6525 GA Nijmegen , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bastiaan","family":"Geelhoed","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Thoraxcentre, University of Groningen, University Medical Center Groningen , 9713 GZ Groningen , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0506-9512","authenticated-orcid":false,"given":"Cornelis P","family":"Allaart","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Amsterdam University Medical Center, Location VU University Medical Center , 1081 HV Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2581-070X","authenticated-orcid":false,"given":"Michiel","family":"Rienstra","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Thoraxcentre, University of Groningen, University Medical Center Groningen , 9713 GZ Groningen , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2556-4534","authenticated-orcid":false,"given":"Alexander H","family":"Maass","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Thoraxcentre, University of Groningen, University Medical Center Groningen , 9713 GZ Groningen , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc A","family":"Vos","sequence":"additional","affiliation":[{"name":"Department of Medical Physiology, University of Utrecht , 3584 CM Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8888-5090","authenticated-orcid":false,"given":"Frits W","family":"Prinzen","sequence":"additional","affiliation":[{"name":"Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , 6229 ER Masstricht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1102-2155","authenticated-orcid":false,"given":"Mathias","family":"Meine","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Utrecht , Heidelberglaan 100, 3584 CX Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6041-6759","authenticated-orcid":false,"given":"Maarten J","family":"Cramer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Utrecht , Heidelberglaan 100, 3584 CX Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,12,6]]},"reference":[{"key":"2022111718402826500_jeab264-B1","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1038\/nrcardio.2014.67","article-title":"Strategies to improve cardiac resynchronization therapy","volume":"11","author":"Vernooy","year":"2014","journal-title":"Nat Rev Cardiol"},{"key":"2022111718402826500_jeab264-B2","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1093\/europace\/eut206","article-title":"2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC)","volume":"15","author":"Brignole","year":"2013","journal-title":"Europace"},{"key":"2022111718402826500_jeab264-B3","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.jacep.2019.10.009","article-title":"Evaluating electrocardiography-based identification of cardiac resynchronization therapy responders beyond current left bundle branch block definitions","volume":"6","author":"van Stipdonk","year":"2020","journal-title":"JACC Clin Electrophysiol"},{"key":"2022111718402826500_jeab264-B4","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1111\/jce.14910","article-title":"Reduction in the QRS area after cardiac resynchronization therapy is associated with survival and echocardiographic response","volume":"32","author":"Ghossein","year":"2021","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2022111718402826500_jeab264-B5","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/europace\/euw445","article-title":"Refining success of cardiac resynchronization therapy using a simple score predicting the amount of reverse ventricular remodelling: results from the Markers and Response to CRT (MARC) study","volume":"20","author":"Maass","year":"2018","journal-title":"Europace"},{"key":"2022111718402826500_jeab264-B6","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.tcm.2018.10.012","article-title":"Mechanism of harm from left bundle branch block","volume":"29","author":"Smiseth","year":"2019","journal-title":"Trends Cardiovasc Med"},{"key":"2022111718402826500_jeab264-B7","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1093\/eurjhf\/hfp107","article-title":"Septal rebound stretch reflects the functional substrate to cardiac resynchronization therapy and predicts volumetric and neurohormonal response","volume":"11","author":"De Boeck","year":"2009","journal-title":"Eur J Heart Fail"},{"key":"2022111718402826500_jeab264-B8","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/j.cardfail.2012.02.001","article-title":"Septal rebound stretch is a strong predictor of outcome after cardiac resynchronization therapy","volume":"18","author":"Leenders","year":"2012","journal-title":"J Card Fail"},{"key":"2022111718402826500_jeab264-B9","doi-asserted-by":"crossref","first-page":"e003744","DOI":"10.1161\/CIRCIMAGING.115.003744","article-title":"Differentiating electromechanical from non-electrical substrates of mechanical discoordination to identify responders to cardiac resynchronization therapy","volume":"8","author":"Lumens","year":"2015","journal-title":"Circ Cardiovasc Imaging"},{"key":"2022111718402826500_jeab264-B10","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1093\/ehjci\/jeaa190","article-title":"The value of septal rebound stretch analysis for the prediction of volumetric response to cardiac resynchronization therapy","volume":"22","author":"Salden","year":"2021","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2022111718402826500_jeab264-B11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"28","author":"Lang","year":"2015","journal-title":"J Am Soc Echocardiogr"},{"key":"2022111718402826500_jeab264-B12","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1093\/eurjhf\/hfq182","article-title":"Left ventricular reverse remodelling, long-term clinical outcome, and mode of death after cardiac resynchronization therapy","volume":"13","author":"Foley","year":"2011","journal-title":"Eur J Heart Fail"},{"key":"2022111718402826500_jeab264-B13","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.1016\/j.jcmg.2018.07.013","article-title":"Systolic stretch characterizes the electromechanical substrate responsive to cardiac resynchronization therapy","volume":"12","author":"Gorcsan","year":"2019","journal-title":"JACC Cardiovasc Imaging"},{"key":"2022111718402826500_jeab264-B14","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1093\/ehjci\/jev288","article-title":"Relationship of visually assessed apical rocking and septal flash to response and long-term survival following cardiac resynchronization therapy (PREDICT-CRT)","volume":"17","author":"Stankovic","year":"2016","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2022111718402826500_jeab264-B15","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.jelectrocard.2019.07.003","article-title":"Fully automated QRS area measurement for predicting response to cardiac resynchronization therapy","volume":"63","author":"Plesinger","year":"2020","journal-title":"J Electrocardiol"},{"key":"2022111718402826500_jeab264-B16","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1007\/s12265-016-9693-1","article-title":"Why QRS duration should be replaced by better measures of electrical activation to improve patient selection for cardiac resynchronization therapy","volume":"9","author":"Engels","year":"2016","journal-title":"J Cardiovasc Transl Res"},{"key":"2022111718402826500_jeab264-B17","doi-asserted-by":"crossref","first-page":"e006497","DOI":"10.1161\/CIRCEP.118.006497","article-title":"QRS Area is a strong determinant of outcome in cardiac resynchronization therapy","volume":"11","author":"van Stipdonk","year":"2018","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2022111718402826500_jeab264-B18","doi-asserted-by":"crossref","first-page":"3813","DOI":"10.1093\/eurheartj\/ehaa603","article-title":"Imaging predictors of response to cardiac resynchronization therapy: left ventricular work asymmetry by echocardiography and septal viability by cardiac magnetic resonance","volume":"41","author":"Aalen","year":"2020","journal-title":"Eur Heart J"},{"key":"2022111718402826500_jeab264-B19","doi-asserted-by":"crossref","first-page":"1903","DOI":"10.1007\/s10554-021-02174-7","article-title":"Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy","volume":"37","author":"Wouters","year":"2021","journal-title":"Int J Cardiovasc Imaging"},{"key":"2022111718402826500_jeab264-B20","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1093\/eurheartj\/ehs016","article-title":"A novel clinical method for quantification of regional left ventricular pressure\u2013strain loop area: a non-invasive index of myocardial work","volume":"33","author":"Russell","year":"2012","journal-title":"Eur Heart J"},{"key":"2022111718402826500_jeab264-B21","doi-asserted-by":"crossref","first-page":"3824","DOI":"10.1093\/eurheartj\/ehaa677","article-title":"Investigating myocardial work as a CRT response predictor is not a waste of work","volume":"41","author":"Prinzen","year":"2020","journal-title":"Eur Heart J"},{"key":"2022111718402826500_jeab264-B22","doi-asserted-by":"crossref","first-page":"2461","DOI":"10.1056\/NEJMoa0706695","article-title":"Cardiac-resynchronization therapy in heart failure with narrow QRS complexes","volume":"357","author":"Beshai","year":"2007","journal-title":"N Engl J Med"},{"key":"2022111718402826500_jeab264-B23","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1056\/NEJMoa1608029","article-title":"Defibrillator implantation in patients with nonischemic systolic heart failure","volume":"375","author":"K\u00f8ber","year":"2016","journal-title":"N Engl J Med"},{"key":"2022111718402826500_jeab264-B24","doi-asserted-by":"crossref","first-page":"2608","DOI":"10.1161\/CIRCULATIONAHA.107.743120","article-title":"Results of the predictors of response to CRT (PROSPECT) trial","volume":"117","author":"Chung","year":"2008","journal-title":"Circulation"},{"key":"2022111718402826500_jeab264-B25","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s12947-017-0116-5","article-title":"Comparison of strain parameters in dyssynchronous heart failure between speckle tracking echocardiography vendor systems","volume":"15","author":"Van Everdingen","year":"2017","journal-title":"Cardiovasc Ultrasound"}],"container-title":["European Heart Journal - Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/23\/12\/1628\/47105055\/jeab264.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/23\/12\/1628\/47105055\/jeab264.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T18:41:05Z","timestamp":1668710465000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article\/23\/12\/1628\/6454061"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,6]]},"references-count":25,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12,6]]},"published-print":{"date-parts":[[2022,11,17]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjci\/jeab264","relation":{},"ISSN":["2047-2404","2047-2412"],"issn-type":[{"value":"2047-2404","type":"print"},{"value":"2047-2412","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,12,1]]},"published":{"date-parts":[[2021,12,6]]}}}