Cardiac Magnetic Resonance Imaging Predicts Transplant Free Survival After Cardiac Resynchronization Therapy in Advanced Heart Failure

Abstract Background Cardiac resynchronization therapy (CRT) restores ventricular synchrony and induces left ventricular (LV) reverse remodeling in patients with heart failure (HF) and dyssynchrony. However, 30% of treated patients are non-responders despite all efforts. Cardiac magnetic resonance imaging (CMR) can be used to quantify regional contributions to stroke volume (SV) as potential CRT predictors. The aim of this study was to determine if LV longitudinal (SVlong%), lateral (SVlat%), and septal (SVsept%) contributions to SV differ from healthy controls and investigate if these parameters can predict CRT response. Methods Sixty-five patients (19 women, 67 ± 9 years) with symptomatic HF (LVEF ≤ 35%) and broadened QRS (≥ 120 ms) underwent CMR. SVlong% was calculated as the volume encompassed by the atrioventricular plane displacement (AVPD) from end diastole (ED) to end systole (ES) divided by total SV. SVlat%, and SVsept% were calculated as the volume encompassed by radial contraction from ED to ES. Twenty age- and sex-matched healthy volunteers were used as controls. The regional measures were compared to outcome response defined as ≥ 15% decrease in echocardiographic LV end-systolic volume (LVESV) from pre- to 6-months post CRT (delta, Δ). Results AVPD and SVlong% were lower in patients compared to controls (8.3 ± 3.2 mm vs 15.3 ± 1.6 mm, P < 0.001; and 53 ± 18% vs 64 ± 8%, P < 0.01). SVsept% was lower (0 ± 15% vs 10 ± 4%, P < 0.01) with a higher SVlat% in the patient group (42 ± 16% vs 29 ± 7%, P < 0.01). There were no differences between responders and non-responders in neither SVlong% (P = 0.87), SVlat% (P = 0.09), nor SVsept% (P = 0.65). In patients with septal net motion towards the right ventricle (n = 28) ΔLVESV was − 18 ± 22% and with septal net motion towards the LV (n = 37) ΔLVESV was − 19 ± 23% (P = 0.96). Conclusions Longitudinal function, expressed as AVPD and longitudinal contribution to SV, is decreased in patients with HF scheduled for CRT. A larger lateral contribution to SV compensates for the abnormal septal systolic net movement. However, LV reverse remodeling could not be predicted by these regional contributors to SV.

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The effectiveness of cardiac resynchronization therapy in patients with chronic heart failure of various origin depending on the structural myocardial injury in cardiac magnetic resonance imaging

Russian Journal of Cardiology ◽

10.15829/1560-4071-2019-12-22-32 ◽

2019 ◽

pp. 22-32

Author(s):

O. V. Stukalova ◽

N. A. Mironova ◽

M. D. Utsumueva ◽

S. Yu. Kashtanova ◽

E. A. Butorova ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Heart Failure ◽

Magnetic Resonance ◽

Cardiac Resynchronization Therapy ◽

Functional Class ◽

Cardiac Resynchronization ◽

Grey Zone ◽

Resonance Imaging ◽

Resynchronization Therapy ◽

Structural Injury

Aim. To assess the effect of the size and pattern of myocardial structural injury, determined by magnetic resonance imaging (MRI), on response to cardiac resynchronization therapy (CRT) in patients with ischemic and non-ischemic heart failure (HF).Material and methods. Forty seven patients with ischemic and non-ischemic HF (age 62,3±8,9 years (mean±SD), 44,6% females and 55,4% males), left ventricle (LV) ejection fraction <35%, QRS complex >130 ms, and sinus rhythm were included in the study. Late-gadolinium enhancement-cardiovascular magnetic resonance (LGE-CMR) was undertaken to evaluate myocardial scar prior to CRT devices implantation. All CMR analysis was performed on CVI42 software. According to signal intensity, fibrosis zone and “grey zone” were defined for quantitative analysis (proportion and mass) of injury. Scar zone included fibrosis zone and “grey zone”. Scar location was assessed using a 16-segmentLV model. Response was defined as a reduction inLV end systolic volume of >15% at 6 months follow-up and HF functional class amelioration.Results. In nonresponse group there was significantly higher proportion and mass of total scar (median 4% [2,5; 19] vs 24% [7; 44], p=0,012,6 g [3,5; 32,5] vs41 g [8; 86], p=0,013)), fibrosis zone (median 0% [0; 3,5] vs 8% [0; 19], p=0,01,0 g [0; 6] vs14 g [0; 34], p=0,014) and “grey zone” (4% [2,5; 15] vs 15% [7; 23], p=0,018,6 g [3,5; 27,5] vs23 g [8; 39], p=0,25). Response proportion in non-ischemic HF patients was higher than in ischemic HF patients (78,5% vs 28,5%, p<0,01). Response to CRT was less in patients with posterolateral scar, more specifically in segments 4,5,6,11,12,15,16 (p<0,05). CRT response in ischemic HF did not depend on size of myocardial structural injury, but depend on scar localization. Lateral scar was associated with poor response. In non-ischemic HF, proportion and mass of fibrosis zone was less in responder group (median 0% [0; 1] vs 8,5% [0; 11], p<0,05,0 g [0; 1] vs14,5 g [0; 22], p<0,05.Conclusion. Response to CRT is significantly higher in non-ischemic than in ischemic HF patients. Nonresponse to CRT is associated with posterolateral scar, regardless of the HF origin. In patients with non-ischemic HF, size of fibrosis zone is lower in the responder group. In patients with ischemic HF, size ofLV structural injury does not affect the CRT efficiency, but lateral scar is associated with CRT nonresponse.

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