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11. The preferred echocardiographic method for AV delay optimization in CRT is: A. E/e′ ratio B. Pulmonary vein flow C. Mitral inflow E–A separation D. Tissue Doppler Ts Optimal AV delay produces longest LV filling without E/A truncation. 12. Which echo parameter is maximized during VV delay optimization? A. EF B. MR jet area C. Septal motion D. LVOT VTI LVOT VTI reflects stroke volume and is the preferred echo marker. 13. Which echocardiographic feature indicates pseudo-nonresponse to CRT? A. No EF improvement B. Inadequate biventricular pacing C. Extensive scar D. RV dysfunction Fusion beats or low BiV pacing percentage can mimic CRT failure. 14. EchoCRT trial showed harm when CRT was used in patients with: A. LBBB B. Septal flash C. EF <30% D. Narrow QRS despite dyssynchrony CRT is contraindicated in narrow QRS even if echo dyssynchrony exists. 15. Which echocardiographic sign best predicts favorable reverse remodeling? A. Apical rocking B. SPWMD C. E/A fusion D. IVMD Apical rocking reflects correctable mechanical dyssynchrony. 16. Which LV segment should be avoided for lead placement? A. Latest activated B. Lateral wall C. Scarred myocardium D. Posterolateral wall Scarred segments do not respond to resynchronization pacing. 17. Reduction in functional MR after CRT is primarily due to: A. Reduced preload B. Improved LV synchrony C. Increased LV contractility D. Shortened PR interval Synchronous contraction restores leaflet coaptation. 18. Which echo finding predicts poor CRT response in AF? A. LV dilation B. MR C. Septal flash D. Variable diastolic filling Irregular RR intervals impair effective resynchronization. 19. GLS improves after CRT due to: A. Increased preload B. Reduced afterload C. Improved synchrony D. Tachycardia CRT restores coordinated myocardial deformation. 20. Which echo parameter best reflects stroke volume? A. EF B. LVOT VTI C. E/e′ D. TAPSE LVOT VTI directly correlates with forward stroke volume. 21. RV dysfunction limits CRT benefit primarily by: A. Reduced EF B. Increased MR C. Delayed LV activation D. Reduced preload to LV RV failure limits LV filling despite resynchronization. 22. Which echo sign resolves early after effective CRT? A. Septal flash B. LV dilation C. MR jet width D. EF Septal flash disappears rapidly with restored synchrony. 23. The best echo marker of long-term prognosis after CRT is: A. EF change B. MR reduction C. LVESV reduction D. TAPSE LVESV reduction strongly correlates with survival. 24. Which echo technique is most angle-independent? A. Tissue Doppler B. M-mode C. PW Doppler D. Speckle tracking Strain imaging is largely angle-independent. 25. Which patient is least likely to respond to CRT? A. LBBB B. Septal flash C. Extensive transmural scar D. Apical rocking Scar prevents electrical–mechanical correction. 26. CRT-induced EF improvement occurs mainly due to: A. Reduced preload B. Improved contractile efficiency C. Tachycardia D. AV block Synchrony improves effective myocardial work. 27. Which echo parameter is most useful to detect fusion beats? A. EF B. MR jet C. Irregular LVOT VTI D. E/A ratio Beat-to-beat LVOT VTI variability suggests fusion. 28. The most reliable echo marker of mechanical synchrony is: A. SPWMD B. IVMD C. TDI Ts D. Strain timing Strain timing reflects true myocardial deformation. 29. In CRT patients, worsening MR suggests: A. Over-resynchronization B. Suboptimal LV lead position C. Improved preload D. Reverse remodeling Improper timing or lead placement can worsen MR. 30. Which echo sign reflects interventricular dyssynchrony? A. Septal flash B. Apical rocking C. MR D. RV–LV pre-ejection delay IVMD >40 ms indicates interventricular delay. 31. Which echo parameter is least useful post-CRT? A. SPWMD B. LVESV C. EF D. MR severity SPWMD has limited reproducibility. 32. Which CRT response parameter best predicts survival? A. EF rise B. LVESV reduction C. GLS D. TAPSE LVESV reduction has strongest prognostic value. 33. Best echo clue of effective LV capture: A. Increased HR B. EF rise C. Narrowed mechanical delay D. MR reduction Mechanical synchrony improves immediately with capture. 34. Which echo parameter improves earliest after CRT? A. LVESV B. Septal flash C. EF D. MR Mechanical dyssynchrony resolves before remodeling. 35. CRT non-response with preserved synchrony suggests: A. Lead failure B. MR progression C. AV delay error D. Myocardial disease Underlying cardiomyopathy may limit response. 36. The best echo view for septal flash detection: A. Parasternal long-axis B. Apical four-chamber C. Subcostal D. Suprasternal PLAX best demonstrates early septal inward motion. 37. Which echo finding suggests suboptimal AV delay? A. Increased EF B. Reduced MR C. Truncated A wave D. Narrow LVOT VTI A-wave truncation indicates excessively short AV delay. 38. Best echo marker to suspect LV lead dislodgement: A. EF drop B. Reappearance of septal flash C. MR D. LV dilation Return of dyssynchrony suggests loss of LV capture. 39. Which echo sign correlates with electrical LBBB correction? A. EF rise B. MR reduction C. LVESV fall D. Resolution of septal flash Septal flash directly reflects LBBB-related dyssynchrony. 40. Ultimate echocardiographic goal of CRT is: A. Narrow QRS B. Increased HR C. Reverse LV remodeling D. Reduced preload Clinical benefit is mediated through reverse remodeling.

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