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Mechanical dyssynchrony (MechDys), visually identified by septal flash and/or apical rocking (SFoAR), is strongly linked to CRT benefit. A practical four-step workflow details acquisition quality, recognition of septal flash4 and apical rocking, confirmation by either motion pattern, and clinical implications for patient selection. The AMEND-CRT trial evaluates whether SFoAR assessment is non-inferior to guideline recommendations; pending prospective data, existing observational evidence supports visual MechDys assessment for intermediate CRT indications.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/how-to-visually-diagnose-mechanical-dyssynchrony-in-cardiac-resynchronization-therapy-candidates-using-echocardiography-short-report/454991/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/how-to-visually-diagnose-mechanical-dyssynchrony-in-cardiac-resynchronization-therapy-candidates-using-echocardiography-short-report/454991.png","ImageObject",300,407,{"name":92,"@type":93},"Elsa","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-07","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":14},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is mechanical dyssynchrony (MechDys) in CRT candidates?","Question",{"text":112,"@type":113},"MechDys is a left-ventricular septal-to-lateral contraction pattern identified visually by septal flash and/or apical rocking (SFoAR). It is strongly associated with CRT benefit.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What visual signs indicate septal flash and apical rocking?",{"text":117,"@type":113},"Septal flash is an early leftward septal motion often with rebound, preceding lateral wall contraction. Apical rocking is a biphasic apical motion reflecting sequential septal and lateral wall contractions.",{"name":119,"@type":110,"acceptedAnswer":120},"How does the proposed workflow help assess MechDys before CRT?",{"text":121,"@type":113},"The workflow emphasizes high-quality multi-view echocardiographic acquisition, then confirms MechDys when either SF or apical rocking is present. It aims to improve CRT patient selection while ongoing evidence from AMEND-CRT evaluates guideline non-inferiority.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},454991,1790741856,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":14,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":129,"read_time":52,"preview_page_count":4},137455077381,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","European Heart Journal-Imaging Methods and Practice (2025) 4, qyaf158 [https://doi.org/10.1093/ehjimp/qyaf158](https://doi.org/10.1093/ehjimp/qyaf158)  \nSHORT REPORT  \nEchocardiography  \nHow to visually diagnose mechanical dyssynchrony in cardiac resynchronization therapy candidates using echocardiography  \nPedro G. Diogo  1, Kenji Demesure1, Alexis Puvrez1,2, Gábor Vörös  1,3, Jürgen Duchenne1,3,4,5, and Jens-Uwe Voigt  1,3,*  \n1Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, Leuven 3000, Belgium  \n2Centre for Heart Rhythm Disorders, University of Adelaide, The Royal Adelaide Hospital Cardiology, Adelaide, SA, Australia 3Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium  \n4Research Group Cardio & Organ Systems, UHasselt, Diepenbeek, Belgium 5Department of Cardiology, Jessa Hospital, Hasselt, Belgium  \nReceived 19 November 2025; accepted after revision 11 December 2025; online publish-ahead-of-print 20 December 2025  \nAbstract Cardiac resynchronization therapy (CRT) improves outcomes in patients with heart failure and broad QRS complex, yet  \n20–45% do not respond. Mechanical dyssynchrony (MechDys)—identified visually by septal flash and/or apical rocking (SFoAR)—is strongly associated with CRT benefit. This ‘How to’ 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.  \nKeywords cardiac resynchronization therapy • left bundle branch block • mechanical dyssynchrony • echocardiography • septal flash • apical rocking  \nIntroduction  \nCardiac resynchronization therapy (CRT) is an established device therapy for patients with heart failure with reduced ejection fraction and abroad QRS complex on surface electrocardiogram.1 CRT has been shown to significantly improve cardiac function and quality of life, and reduce morbidity and mortality. However, not all patients derive equal benefit from CRT, with non-response reported in 20–45% of cases1 . Current guidelines suggest that patients with a broad QRS complex  \nwith left bundle branch block (LBBB) morphology derive the most benefit, while patients with a narrower LBBB or non-LBBB benefit less. Selecting the right patients for this therapy is therefore a challenging task.  \nIndeed, although delayed LV electrical conduction is the underlying cause, the pathophysiological remodelling and eventually heart failure in these patients is rather driven by the resulting dyssynchronous mechanical activation of the LV and the subsequent imbalance in regional myocardial loading. There is a significant body of evidence suggesting  \n* Corresponding author. E-mail: [jens-uwe.voigt@uzleuven.be](jens-uwe.voigt@uzleuven.be)  \n© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.  \nThis is an Open Access article distributed under the terms of the Creative Commons Attribution License ([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)), which permits unrestricted reuse, distr","cbCaimv4lpV4Jl8i","https://ap.wps.com/l/cbCaimv4lpV4Jl8i","pdf",284041,"English","# Introduction\n## Cardiac resynchronization therapy and patient selection challenges\n## Mechanical dyssynchrony and echocardiographic markers\n## Visual assessment workflow\n# Step 1: image acquisition and view selection","[{\"question\":\"What is mechanical dyssynchrony (MechDys) in CRT candidates?\",\"answer\":\"MechDys is a left-ventricular septal-to-lateral contraction pattern identified visually by septal flash and/or apical rocking (SFoAR). It is strongly associated with CRT benefit.\"},{\"question\":\"What visual signs indicate septal flash and apical rocking?\",\"answer\":\"Septal flash is an early leftward septal motion often with rebound, preceding lateral wall contraction. Apical rocking is a biphasic apical motion reflecting sequential septal and lateral wall contractions.\"},{\"question\":\"How does the proposed workflow help assess MechDys before CRT?\",\"answer\":\"The workflow emphasizes high-quality multi-view echocardiographic acquisition, then confirms MechDys when either SF or apical rocking is present. It aims to improve CRT patient selection while ongoing evidence from AMEND-CRT evaluates guideline non-inferiority.\"}]","How to visually diagnose mechanical dyssynchrony in cardiac resynchronization therapy candidates using echocardiography - Short report | PDF"]