{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T19:54:22Z","timestamp":1776801262762,"version":"3.51.2"},"reference-count":37,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2021,12,24]],"date-time":"2021-12-24T00:00:00Z","timestamp":1640304000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Cardiac resynchronization therapy (CRT) represents an increasingly recommended solution to alleviate symptomatology and improve the quality of life in individuals with dilated cardiomyopathy (DCM) and heart failure (HF) with reduced ejection fraction (HFrEF) who remain symptomatic despite optimal medical therapy (OMT). However, this therapy does have the desired results all cases, in that sometimes low sensing and high voltage stimulation are needed to obtain some degree of resynchronization, even in the case of perfectly placed cardiac pacing leads. Our study aims to identify whether there is a relationship between several transthoracic echocardiographic (TTE) parameters characterizing left ventricular (LV) performance, especially strain results, and sensing and pacing parameters. Between 2020\u20132021, CRT was performed to treat persistent symptoms in 48 patients with a mean age of 64 (53.25\u201370) years, who were diagnosed with DCM and HFrEF, and who were still symptomatic despite OMT. We documented statistically significant correlations between global longitudinal strain, posterolateral strain, and ejection fraction and LV sensing (r = 0.65, 0.469, and 0.534, respectively, p &lt; 0.001) and LV pacing parameters (r = \u22120.567, \u22120.555, and \u22120.363, respectively, p &lt; 0.001). Modern imaging techniques, such as TTE with cardiac strain, are contributing to the evaluation of patients with HFrEF, increasing the chances of CRT success, and allowing physicians to anticipate and plan for case management.<\/jats:p>","DOI":"10.3390\/diagnostics12010035","type":"journal-article","created":{"date-parts":[[2021,12,24]],"date-time":"2021-12-24T08:38:46Z","timestamp":1640335126000},"page":"35","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Echocardiographic Parameters as Predictors for the Efficiency of Resynchronization Therapy in Patients with Dilated Cardiomyopathy and HFrEF"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1697-311X","authenticated-orcid":false,"given":"Silvius-Alexandru","family":"Pescariu","sequence":"first","affiliation":[{"name":"Department VI, Discipline of Cardiology, University of Medicine and Pharmacy \u201cVictor Babes\u201d Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania"},{"name":"Cardiology Clinic, Institute of Cardiovascular Medicine Timi\u015foara, 13A, Gheorghe Adam Street, 300310 Timisoara, Romania"},{"name":"Research Center for Cardiovascular Diseases, Institute of Cardiovascular Diseases, 300310 Timisoara, Romania"},{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5998-2932","authenticated-orcid":false,"given":"Raluca","family":"\u015eo\u015fdean","sequence":"additional","affiliation":[{"name":"Department VI, Discipline of Cardiology, University of Medicine and Pharmacy \u201cVictor Babes\u201d Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania"},{"name":"Cardiology Clinic, Institute of Cardiovascular Medicine Timi\u015foara, 13A, Gheorghe Adam Street, 300310 Timisoara, Romania"},{"name":"Research Center for Cardiovascular Diseases, Institute of Cardiovascular Diseases, 300310 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7351-741X","authenticated-orcid":false,"given":"Cristina","family":"Tudoran","sequence":"additional","affiliation":[{"name":"Department VII, Internal Medicine II, Discipline of Cardiology, University of Medicine and Pharmacy \u201cVictor Babes\u201d Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania"},{"name":"Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy \u201cVictor Babes\u201d Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania"},{"name":"County Emergency Hospital, L. Rebreanu Str., Nr. 156, 300723 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adina","family":"Ionac","sequence":"additional","affiliation":[{"name":"Department VI, Discipline of Cardiology, University of Medicine and Pharmacy \u201cVictor Babes\u201d Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania"},{"name":"Cardiology Clinic, Institute of Cardiovascular Medicine Timi\u015foara, 13A, Gheorghe Adam Street, 300310 Timisoara, Romania"},{"name":"Research Center for Cardiovascular Diseases, Institute of Cardiovascular Diseases, 300310 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9947-8316","authenticated-orcid":false,"given":"Gheorghe Nicusor","family":"Pop","sequence":"additional","affiliation":[{"name":"Department VI, Discipline of Cardiology, University of Medicine and Pharmacy \u201cVictor Babes\u201d Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Romulus Zorin","family":"Timar","sequence":"additional","affiliation":[{"name":"Department VII, Internal Medicine II, Discipline of Cardiology, University of Medicine and Pharmacy \u201cVictor Babes\u201d Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania"},{"name":"Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy \u201cVictor Babes\u201d Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania"},{"name":"County Emergency Hospital, L. Rebreanu Str., Nr. 156, 300723 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sorin","family":"Pescariu","sequence":"additional","affiliation":[{"name":"Department VI, Discipline of Cardiology, University of Medicine and Pharmacy \u201cVictor Babes\u201d Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania"},{"name":"Cardiology Clinic, Institute of Cardiovascular Medicine Timi\u015foara, 13A, Gheorghe Adam Street, 300310 Timisoara, Romania"},{"name":"Research Center for Cardiovascular Diseases, Institute of Cardiovascular Diseases, 300310 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariana","family":"Tudoran","sequence":"additional","affiliation":[{"name":"Department VII, Internal Medicine II, Discipline of Cardiology, University of Medicine and Pharmacy \u201cVictor Babes\u201d Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania"},{"name":"Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy \u201cVictor Babes\u201d Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania"},{"name":"County Emergency Hospital, L. Rebreanu Str., Nr. 156, 300723 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,24]]},"reference":[{"key":"ref_1","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":"ref_2","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1016\/j.hlc.2019.03.012","article-title":"Echocardiographic Strain in Clinical Practice","volume":"28","author":"Trivedi","year":"2019","journal-title":"Heart Lung Circ."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1093\/ehjci\/jey042","article-title":"Standardization of Left Atrial, Right Ventricular, and Right Atrial Deformation Imaging Using Two-Dimensional Speckle Tracking Echocardiography: A Consensus Document of the EACVI\/ASE\/Industry Task Force to Standardize Deformation Imaging","volume":"19","author":"Badano","year":"2018","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"137","DOI":"10.4250\/jcvi.2019.0111","article-title":"Left Ventricular Global Longitudinal Strain as a Predictor for Left Ventricular Reverse Remodeling in Dilated Cardiomyopathy","volume":"28","author":"Jung","year":"2020","journal-title":"J. Cardiovasc. Imaging"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/j.amjcard.2014.07.018","article-title":"Myocardial Deformation Imaging by Two-Dimensional Speckle-Tracking Echocardiography in Comparison to Late Gadolinium Enhancement Cardiac Magnetic Resonance for Analysis of Myocardial Fibrosis in Severe Aortic Stenosis","volume":"114","author":"Hoffmann","year":"2014","journal-title":"Am. J. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.jcmg.2017.02.014","article-title":"Intervendor Differences in the Accuracy of Detecting Regional Functional Abnormalities","volume":"11","author":"Mirea","year":"2018","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1093\/ehjci\/jex140","article-title":"Echocardiographic Reference Ranges for Normal Left Ventricular 2D Strain: Results from the EACVI NORRE Study","volume":"18","author":"Sugimoto","year":"2017","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"147","DOI":"10.2459\/JCM.0b013e3283638d90","article-title":"Cardiac Resynchronization Therapy: Implant Rates, Temporal Trends and Relationships with Heart Failure Epidemiology","volume":"15","author":"Boriani","year":"2014","journal-title":"J. Cardiovasc. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"i11","DOI":"10.1093\/ejcts\/ezy488","article-title":"Change in Indication for Cardiac Resynchronization Therapy?","volume":"55","author":"Lawin","year":"2019","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_10","unstructured":"(2021). 2021 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy. Eur. Heart J., 42, 3427\u20133520. Available online: https:\/\/academic.oup.com\/eurheartj\/article\/42\/35\/3427\/6358547."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.jacc.2008.02.032","article-title":"ACC\/AHA\/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities","volume":"51","author":"Epstein","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Authors\/Task Force Members, Brignole, M., Auricchio, A., Baron-Esquivias, G., Bordachar, P., Boriani, G., Breithardt, O.-A., Cleland, J., Deharo, J.-C., and Delgado, V. (2013). 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). Developed in Collaboration with the European Heart Rhythm Association (EHRA). Europace, 15, 1070\u20131118.","DOI":"10.1093\/europace\/eut206"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1111\/pace.12992","article-title":"Clinical Cardiac Pacing, Defibrillation, and Resynchronization Therapy, 5th Edition. By Kenneth A. Ellenbogen, Bruce L. Wilkoff, G. Neal Kay, Chu-Pak Lau, and Angelo Auricchio. Philadelphia, PA: Elsevier, Inc., 1232 Pages, ISBN: 978-0-323-37804-8.: BOOK REVIEW","volume":"40","author":"Chugh","year":"2017","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1016\/j.hrthm.2011.12.014","article-title":"Incidence and Predictors of Short- and Long-Term Complications in Pacemaker Therapy: The FOLLOWPACE Study","volume":"9","author":"Udo","year":"2012","journal-title":"Heart Rhythm"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1093\/europace\/euq190","article-title":"Predictors of Inappropriate Atrial Sensing in Long-Term VDD-Pacing Systems","volume":"12","author":"Huang","year":"2010","journal-title":"Europace"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1161\/CIRCULATIONAHA.110.976076","article-title":"Complication Rates Associated with Pacemaker or Implantable Cardioverter-Defibrillator Generator Replacements and Upgrade Procedures: Results From the REPLACE Registry","volume":"122","author":"Poole","year":"2010","journal-title":"Circulation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.1016\/j.jacc.2007.01.072","article-title":"Management and Outcome of Permanent Pacemaker and Implantable Cardioverter-Defibrillator Infections","volume":"49","author":"Sohail","year":"2007","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1016\/j.echo.2005.10.005","article-title":"Recommendations for Chamber Quantification: A Report from the American Society of Echocardiography\u2019s Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in Conjunction with the European Association of Echocardiography, a Branch of the European Society of Cardiology","volume":"18","author":"Lang","year":"2005","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_19","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":"ref_20","doi-asserted-by":"crossref","unstructured":"(2013). Normal Ranges of Left Ventricular Strain: A Meta-Analysis. J. Am. Soc. Echocardiogr., 26, 185\u2013191.","DOI":"10.1016\/j.echo.2012.10.008"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"655","DOI":"10.2217\/fca-2020-0121","article-title":"Abnormal Left Ventricular Global Longitudinal Strain by Speckle Tracking Echocardiography in COVID-19 Patients","volume":"17","author":"Croft","year":"2020","journal-title":"Future Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.1148\/rg.321115014","article-title":"Coronary Veins: Comprehensive CT-Anatomic Classification and Review of Variants and Clinical Implications","volume":"32","author":"Saremi","year":"2012","journal-title":"Radiographics"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1161\/CIRCHEARTFAILURE.113.000838","article-title":"Clinical Effectiveness of Cardiac Resynchronization Therapy Versus Medical Therapy Alone Among Patients with Heart Failure: Analysis of the ICD Registry and ADHERE","volume":"7","author":"Khazanie","year":"2014","journal-title":"Circ. Heart Fail."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2349","DOI":"10.1002\/ejhf.2046","article-title":"Optimized Implementation of Cardiac Resynchronization Therapy: A Call for Action for Referral and Optimization of Care: A Joint Position Statement from the Heart Failure Association (HFA), European Heart Rhythm Association (EHRA), and European Association of Cardiovascular Imaging (EACVI) of the European Society of Cardiology","volume":"22","author":"Mullens","year":"2020","journal-title":"Eur. J. Heart Fail."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1002\/ejhf.143","article-title":"Echocardiographic and Clinical Response to Cardiac Resynchronization Therapy in Heart Failure Patients with and without Previous Right Ventricular Pacing","volume":"16","author":"Gage","year":"2014","journal-title":"Eur. J. Heart Fail."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1093\/ehjci\/jey029","article-title":"Assessment of Mechanical Dyssynchrony Can Improve the Prognostic Value of Guideline-Based Patient Selection for Cardiac Resynchronization Therapy","volume":"20","author":"Beela","year":"2019","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.ejheart.2005.11.014","article-title":"Cardiac Resynchronisation for Patients with Heart Failure Due to Left Ventricular Systolic Dysfunction\u2014A Systematic Review and Meta-Analysis","volume":"8","author":"Freemantle","year":"2006","journal-title":"Eur. J. Heart Fail."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1016\/j.hrthm.2011.04.015","article-title":"Cardiac Resynchronization Therapy and the Relationship of Percent Biventricular Pacing to Symptoms and Survival","volume":"8","author":"Hayes","year":"2011","journal-title":"Heart Rhythm"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.jchf.2018.01.022","article-title":"Indications for Cardiac Resynchronization Therapy","volume":"6","author":"Normand","year":"2018","journal-title":"JACC Heart Fail."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1093\/europace\/euaa067","article-title":"Adherence to ESC Cardiac Resynchronization Therapy Guidelines: Findings from the ESC CRT Survey II","volume":"22","author":"Normand","year":"2020","journal-title":"Europace"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"401","DOI":"10.7326\/0003-4819-154-6-201103150-00313","article-title":"Meta-Analysis: Cardiac Resynchronization Therapy for Patients with Less Symptomatic Heart Failure","volume":"154","author":"McAlister","year":"2011","journal-title":"Ann. Intern. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1093\/eurheartj\/ehq389","article-title":"Impact of Scar Burden by Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging on Patient Outcomes Following Cardiac Resynchronization Therapy","volume":"32","author":"Adelstein","year":"2011","journal-title":"Eur. Heart. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1093\/europace\/eum133","article-title":"Late Gadolinium Enhancement-Cardiovascular Magnetic Resonance as a Predictor of Response to Cardiac Resynchronization Therapy in Patients with Ischaemic Cardiomyopathy","volume":"9","author":"Chalil","year":"2007","journal-title":"Europace"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e617","DOI":"10.1161\/CIRCULATIONAHA.110.017400","article-title":"Targeting Viable Myocardium in Cardiac Resynchronization Therapy Using a Multipolar Left Ventricular Lead","volume":"123","author":"Abozguia","year":"2011","journal-title":"Circulation"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.ijcard.2011.12.006","article-title":"Pacing Transmural Scar Tissue Reduces Left Ventricle Reverse Remodeling after Cardiac Resynchronization Therapy","volume":"167","author":"Mele","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1016\/j.hrthm.2019.03.027","article-title":"Pacing in Proximity to Scar during Cardiac Resynchronization Therapy Increases Local Dispersion of Repolarization and Susceptibility to Ventricular Arrhythmogenesis","volume":"16","author":"Neic","year":"2019","journal-title":"Heart Rhythm"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1007\/s12265-017-9779-4","article-title":"Computational Modeling for Cardiac Resynchronization Therapy","volume":"11","author":"Lee","year":"2018","journal-title":"J. Cardiovasc. Transl. Res."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/1\/35\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:52:53Z","timestamp":1760169173000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/1\/35"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,24]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["diagnostics12010035"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics12010035","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,24]]}}}