{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T18:44:34Z","timestamp":1767811474856,"version":"3.49.0"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T00:00:00Z","timestamp":1766275200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003130","name":"Research Foundation Flanders","doi-asserted-by":"publisher","award":["T002919N"],"award-info":[{"award-number":["T002919N"]}],"id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003130","name":"FWO","doi-asserted-by":"publisher","award":["12ZZ22N"],"award-info":[{"award-number":["12ZZ22N"]}],"id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003130","name":"FWO","doi-asserted-by":"publisher","award":["1832917N"],"award-info":[{"award-number":["1832917N"]}],"id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Frans Van de Werf Fund for Clinical Cardiovascular Research"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Cardiac resynchronization therapy (CRT) improves outcomes in patients with heart failure and broad QRS complex, yet 20\u201345% do not respond. Mechanical dyssynchrony (MechDys)\u2014identified visually by septal flash and\/or apical rocking (SFoAR)\u2014is strongly associated with CRT benefit. This \u2018How to\u2019 paper outlines a practical four-step workflow for the visual assessment of MechDys. First, a high-quality, multi-view echocardiographic acquisition is essential. Second, septal flash4 (SF) is recognized as an early leftward septal motion, often with rebound, preceding lateral wall contraction; its magnitude depends on conduction delay, myocardial contractility, and right heart loading. Third, ApR is identified as a biphasic apical motion reflecting sequential septal and lateral wall contractions; its appearance may be modified by scarring, pacing, or imaging artefacts. MechDys is confirmed when either motion pattern is present. Clinically, the visual assessment of MechDys may improve patient selection for CRT, thus improving response rates. The ongoing AMEND-CRT trial is evaluating whether incorporating SFoAR assessment is non-inferior to guideline recommendations. Pending prospective evidence, existing observational data supports the use of visual assessment of MechDys to guide decision-making in patients with intermediate CRT indications.<\/jats:p>","DOI":"10.1093\/ehjimp\/qyaf158","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T12:58:17Z","timestamp":1766149097000},"source":"Crossref","is-referenced-by-count":0,"title":["How to visually diagnose mechanical dyssynchrony in cardiac resynchronization therapy candidates using echocardiography"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1028-4890","authenticated-orcid":false,"given":"Pedro G","family":"Diogo","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Sciences, KU Leuven , Herestraat 49, Leuven 3000 ,","place":["Belgium"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenji","family":"Demesure","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, KU Leuven , Herestraat 49, Leuven 3000 ,","place":["Belgium"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexis","family":"Puvrez","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, KU Leuven , Herestraat 49, Leuven 3000 ,","place":["Belgium"]},{"name":"Centre for Heart Rhythm Disorders, University of Adelaide , The Royal Adelaide Hospital Cardiology, Adelaide, SA ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3077-0914","authenticated-orcid":false,"given":"G\u00e1bor","family":"V\u00f6r\u00f6s","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, KU Leuven , Herestraat 49, Leuven 3000 ,","place":["Belgium"]},{"name":"Department of Cardiovascular Diseases, University Hospitals Leuven , Leuven ,","place":["Belgium"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00fcrgen","family":"Duchenne","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, KU Leuven , Herestraat 49, Leuven 3000 ,","place":["Belgium"]},{"name":"Department of Cardiovascular Diseases, University Hospitals Leuven , Leuven ,","place":["Belgium"]},{"name":"Research Group Cardio & Organ Systems, UHasselt , Diepenbeek ,","place":["Belgium"]},{"name":"Department of Cardiology, Jessa Hospital , Hasselt ,","place":["Belgium"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0575-1888","authenticated-orcid":false,"given":"Jens-Uwe","family":"Voigt","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, KU Leuven , Herestraat 49, Leuven 3000 ,","place":["Belgium"]},{"name":"Department of Cardiovascular Diseases, University Hospitals Leuven , Leuven ,","place":["Belgium"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,12,20]]},"reference":[{"key":"2026010712322775800_qyaf158-B1","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"key":"2026010712322775800_qyaf158-B2","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 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