scholarly journals Epicardial Adipose Tissue Measured From Computed Tomography Predicts Cardiac Resynchronization Therapy Response in Patients With Non-ischemic Systolic Heart Failure

2021 ◽  
Vol 8 ◽  
Author(s):  
Hui-yuan Qin ◽  
Cheng Wang ◽  
Duo-duo Qian ◽  
Chang Cui ◽  
Ming-long Chen
Keyword(s):  
Heart Failure ◽  
Adipose Tissue ◽  
Regression Analysis ◽  
Epicardial Adipose Tissue ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Qrs Duration ◽  
Response Group ◽  
Crt Response

Background: Epicardial adipose tissue (EAT) has been linked with the pathogenesis of heart failure (HF). Limited data have been reported about the clinical value of EAT for cardiac resynchronization therapy (CRT) in non-ischemic systolic HF. We aimed to explore the values of EAT measured from CT to predict the response to CRT in patients with non-ischemic systolic HF.Methods: Forty-one patients with CRT were consecutively recruited for our study. All patients received both gated resting Single Photon Emission CT (SPECT) myocardial perfusion imaging (MPI) and dual-source multi-detector row CT scans. EAT thickness was assessed on both the parasternal short and horizontal long-axis views. The area of EAT was calculated at the left main coronary artery level. Left ventricular systolic mechanical dyssynchrony (LVMD) was measured by phase standard deviation (PSD) and phase histogram bandwidth (PBW). The definition of CRT response was an improvement of 5% in left ventricular ejection fraction (LVEF) at 6 months after CRT implantation.Results: After 6 months of follow-up, 58.5% (24 of 41) of patients responded to CRT. A greater total perfusion deficit (TPD) was observed in the left ventricle, and a narrower QRS complex was observed in the nonresponse group than in the response group (p < 0.05). Meanwhile, the systolic PSD and systolic PBW were statistically greater in the CRT group with no response than in the response group (p < 0.05). Meanwhile, the baseline QRS duration, TPD, systolic PSD, systolic PBW, EAT thicknesses of the left ventricular (LV) apex, right atrioventricular (AV) groove, and left AV groove were all significantly related to the CRT response in the univariate logistic regression analysis. Furthermore, the QRS duration and EAT thicknesses of the right AV groove and left AV groove were independent predictors of CRT response in the multivariate logistic regression analysis.Conclusions: The EAT thickness of the left AV groove in patients with non-ischemic systolic HF is associated with the TPD of LV and LV systolic dyssynchrony. The EAT thickness of the AV groove has a good predictive value for the CRT response in patients with non-ischemic systolic HF.

scholarly journals LOCALIZATION OF THE LEFT VENTRICULAR MYOCARDIAL SCARRING AND ITS ELECTRICAL ACTIVATION IN PATIENTS WITH HEART FAILURE AND DIFFERENT RESPONSE TO CARDIAC RESYNCHRONIZATION THERAPY

2020 ◽  
Vol 26 (3) ◽  
pp. 5-14
Author(s):  
M. D. Utsumueva ◽  
N. A. Mironova ◽  
O. V. Stukalova ◽  
E. M. Gupalo ◽  
S. Yu. Kashtanova ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Patients With Heart Failure ◽  
Qrs Duration ◽  
Response Group ◽  
Crt Response ◽  
Device Programming

Introduction. As a significant number of patients with heart failure (HF) does not respond to cardiac resynchronization therapy (CRT), a lot of research has deservedly focused on optimization, and better patient selection. The ideal resynchronization depends on different factors, from device programming to heart features and left ventricle (LV) lead position. Analysis of the 12-lead electrocardiogram (ECG) is the most simple method which can provide important information on LV lead location, presence of scar at LV pacing site, and fusion of intrinsic activation or RV pacing with LV pacing.Purpose. To analyze the electrophysiological and structural heart features and their correlation with the ECG pattern during biventricular (BV) pacing in patients with HF and CRT devices.Methods. The study included 47 patients (mean age 62.3±8.9 years) with LBBB, QRS duration ≥ 130 ms, left ventricular ejection fraction (LVEF) ≤ 35%, heart failure (HF) NYHA II-IV despite optimal pharmacological therapy during months. All patients had undergone CRT-D implantation. Late-gadolinium enhancement-cardiovascular magnetic resonance (LGE-CMR), 12-lead ECG, non-invasive cardiac mapping (NICM) (with obtaining the zone of late LV activation (ZLA)) were undertaken prior to CRT devices implantation. NICM with cardiac CT and evaluation of LV lead position, ECG pattern during BV pacing (#1 - fusion complex with increased or dominant R wave, independent of QRS duration, #2- QS pattern with QRS duration normalization, and #3- QS pattern with increased QRS duration) were undertaken after CRT devices implantation. Response to CRT was estimated by echo and was defined as decrease in LV end-systolic volume by > 15% after 6 months of follow-up.Results. CRT was effective in 28 patients (59.5%). According to the results of NICM, zone of late LV activation more often was located at 5,6,11,12 segments, and LV pacing site - at 6,7,12 segments of LV. In the “response” group overlap of scar zone and zone of late LV activation was observed (p=0.005). The presence of scar tissue in the LV pacing site was associated with CRT non-response (p<0.001), and the pacing zone of late LV activation resulted in the best CRT response (p<0.001). The distance from the LV electrode to the zone of late LV activation was less in the “CRT response” group (33 [20;42] mm vs 83 [55;100] mm, p<0.001). The most beneficial ECG pattern during BV pacing was #2, and #3 was more often observed in the group “CRT non-response”; configuration #1 was intermediate between ECG patterns #2 and #3.Conclusions. A comprehensive examination, including the study of the structural and electrophysiological heart features is important for the optimal positioning the LV lead and subsequent CRT device programming. The simple analysis of the QRS pattern during BV pacing can show whether biventricular pacing is adequately performed and can reveal inadequate CRT programming and LV lead positioning.

P3802Electrophysiological and structural heart features in patients with heart failure and response to cardiac resynchronization therapy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Utsumueva ◽  
O Stukalova ◽  
N Mironova ◽  
S Kashtanova ◽  
T Malkina ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Lead Position ◽  
Patients With Heart Failure ◽  
Qrs Duration ◽  
Response Group ◽  
Crt Response ◽  
Device Programming

Abstract Introduction As a significant number of patients with heart failure (HF) does not respond to cardiac resynchronization therapy (CRT), a lot of research has deservedly focused on optimization, and better patient selection. The ideal resynchronization depends on different factors, from device programming to heart features and left ventricle (LV) lead position. Analysis of the 12 lead electrocardiogram (ECG) is the most simple method which can provide important information on LV lead location, presence of scar at LV pacing site, and fusion of intrinsic activation or RV pacing with LV pacing. Purpose To analyze the electrophysiological and structural heart features and their correlation with the ECG pattern during biventricular (BV) pacing in patients with HF and CRT devices. Methods The study included 47 patients (mean age 62,3±8,9 yrs) with LBBB, QRS≥130 ms, LV ejection fraction (LVEF) ≤35%, heart failure (HF) NYHA II-IV despite optimal pharmacological therapy during 3 months. All patients had undergone CRT-D implantation. Late-gadolinium enhancement-cardiovascular magnetic resonance, 12 lead ECG, non-invasive cardiac mapping (NICM) (with obtaining the zone of late LV activation were undertaken prior to CRT devices implantation. NICM with cardiac CT and evaluation of LV lead position, ECG pattern during BV pacing (#1 - fusion complex with increased or dominant R wave, independent of QRS duration, #2- QS pattern with QRS duration normalization, and #3- QS pattern with increased QRS duration) were undertaken after CRT devices implantation. Response to CRT was estimated by echo and was defined as decrease in LV end-systolic volume by >15% after 6 months of follow-up. Results CRT was effective in 28 patients (59,5%). According to the results of NICM, zone of late LV activation more often was located at 5,6,11,12 segments, and LV pacing site – at 6,7,12 segments of LV. In the “response” group overlap of scar zone and zone of late LV activation was observed (p=0,005). The presence of scar tissue in the LV pacing site was associated with CRT non-response (p<0.001), and the pacing zone of late LV activation resulted in the best CRT response (p<0.001). The distance from the LV electrode to the zone of late LV activation was less in the “CRT response” group (33 [20; 42] mm vs 83 [55; 100] mm, p<0.001). The most beneficial ECG pattern during BV pacing was #2, which found more often found in case of pacing zone of late LV activation. Configuration #3 was more often observed in the group “CRT non-response”; #1 was intermediate between ECG patterns #2 and #3. Conclusions A comprehensive examination, including the study of the structural and electrophysiological heart features is important for the optimal positioning the LV lead and subsequent CRT device programming. The simple analysis of the QRS pattern during BV pacing can show whether biventricular pacing is adequately performed and can reveal inadequate CRT programming and LV lead positioning.

scholarly journals Importance of systematic right ventricular assessment in cardiac resynchronization therapy candidates: a machine-learning approach

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Galli ◽  
V Le Rolle ◽  
OA Smiseth ◽  
J Duchenne ◽  
JM Aalen ◽  
...  
Keyword(s):  
Machine Learning ◽  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Right Ventricular ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Supervised Machine Learning ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Crt Response

Abstract Funding Acknowledgements Type of funding sources: None. Background Despite having all a systolic heart failure and broad QRS, patients proposed for cardiac resynchronization therapy (CRT) are highly heterogeneous and it remains extremely complicated to predict the impact of the device on left ventricular (LV) function and outcomes. Objectives We sought to evaluate the relative impact of clinical, electrocardiographic, and echocardiographic data on the left ventricular (LV) remodeling and prognosis of CRT-candidates by the application of machine learning (ML) approaches. Methods 193 patients with systolic heart failure undergoing CRT according to current recommendations were prospectively included in this multicentre study. We used a combination of the Boruta algorithm and random forest methods to identify features predicting both CRT volumetric response and prognosis (Figure 1). The model performance was tested by the area under the receiver operating curve (AUC). We also applied the K-medoid method to identify clusters of phenotypically-similar patients. Results From 28 clinical, electrocardiographic, and echocardiographic-derived variables, 16 features were predictive of CRT-response; 11 features were predictive of prognosis. Among the predictors of CRT-response, 7 variables (44%) pertained to right ventricular (RV) size or function. Tricuspid annular plane systolic excursion was the main feature associated with prognosis. The selected features were associated with a very good prediction of both CRT response (AUC 0.81, 95% CI: 0.74-0.87) and outcomes (AUC 0.84, 95% CI: 0.75-0.93) (Figure 1, Supervised Machine Learning Panel). An unsupervised ML approach allowed the identifications of two phenogroups of patients who differed significantly in clinical and parameters, biventricular size and RV function. The two phenogroups had significant different prognosis (HR 4.70, 95% CI: 2.1-10.0, p &lt; 0.0001; log –rank p &lt; 0.0001; Figure 1, Unsupervised Machine Learning Panel). Conclusions Machine learning can reliably identify clinical and echocardiographic features associated with CRT-response and prognosis. The evaluation of both RV-size and function parameters has pivotal importance for the risk stratification of CRT-candidates and should be systematically assessed in patients undergoing CRT. Abstract Figure 1

scholarly journals Narrower QRS may be enough to respond to cardiac resynchronization therapy in lightweight patients

2019 ◽  
Vol 35 (6) ◽  
pp. 835-841 ◽  
Author(s):  
Toshiko Nakai ◽  
Hiroaki Mano ◽  
Yukitoshi Ikeya ◽  
Yoshihiro Aizawa ◽  
Sayaka Kurokawa ◽  
...  
Keyword(s):  
Body Size ◽  
Cardiac Resynchronization Therapy ◽  
Response Rate ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Conduction Disturbances ◽  
Body Sizes ◽  
Qrs Duration ◽  
Crt Response

AbstractA prolonged QRS duration (QRSd) is promising for a response to cardiac resynchronization therapy (CRT). The variation in human body sizes may affect the QRSd. We hypothesized that conduction disturbances may exist in Japanese even with a narrow (< 130 ms)-QRS complex; such patients could be CRT candidates. We investigated the relationships between QRSd and sex and body size in Japanese. We retrospectively analyzed the values of 338 patients without heart failure (HF) (controls) and 199 CRT patients: 12-lead electrocardiographically determined QRSd, left ventricular diastolic and systolic diameters (LVDd and LVDs), body surface area (BSA), body mass index (BMI), and LVEF. We investigated the relationships between the QRSd and BSA, BMI, and LVD. The men’s and women’s BSA values were 1.74 m2 and 1.48 m2 in the controls (p < 0.0001), and 1.70 m2 and 1.41 m2 in the CRT patients (p < 0.0001). The men’s and women’s QRSd values were 96.1 ms and 87.4 ms in the controls (p < 0.0001), and 147.8 ms and 143.9 ms in the CRT group (p = 0.4633). In the controls, all body size and LVD variables were positively associated with QRSd. The CRT response rate did not differ significantly among narrow-, mid-, and wide-QRS groups (83.6%, 91.3%, 92.4%). An analysis of the ROC curve provided a QRS cutoff value of 114 ms for CRT responder. The QRSd appears to depend somewhat on body size in patients without HF. The CRT response rate was better than reported values even in patients with a narrow QRSd (< 130 ms). When patients are considered for CRT, a QRSd > 130 ms may not be necessary, and the current JCS guidelines appear to be appropriate.

scholarly journals Cardiac index in atrio- and interventricular delay optimized cardiac resynchronization therapy and cardiac contractility modulation

2015 ◽  
Vol 1 (1) ◽  
pp. 89-91 ◽  
Author(s):  
J. Tumampos ◽  
N. Wulf ◽  
H. Kühnert ◽  
O. Solbrig ◽  
J. Querengässer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Index ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Contractility ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Cardiac Contractility Modulation ◽  
Heart Failure Patients ◽  
Qrs Duration

AbstractCardiac resynchronization therapy (CRT) is an established therapy for heart failure patients and improves quality of life in patients with sinus rhythm, reduced left ventricular ejection fraction (LVEF), left bundle branch block and wide QRS duration. Since approximately sixty percent of heart failure patients have a normal QRS duration they do not benefit or respond to the CRT. Cardiac contractility modulation (CCM) releases nonexcitatoy impulses during the absolute refractory period in order to enhance the strength of the left ventricular contraction. The aim of the investigation was to evaluate differences in cardiac index between optimized and nonoptimized CRT and CCM devices versus standard values. Impedance cardiography, a noninvasive method was used to measure cardiac index (CI), a useful parameter which describes the blood volume during one minutes heart pumps related to the body surface. CRT patients indicate an increase of 39.74 percent and CCM patients an improvement of 21.89 percent more cardiac index with an optimized device.

scholarly journals Correlation between QRS duration and cardiac output measured by left ventricular outflow tract velocity in patient with cardiac resynchronization therapy

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A S A E Elshikh ◽  
M M Khalifa ◽  
H Shehata ◽  
A Murtada
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Left Ventricular Outflow ◽  
Qrs Duration ◽  
Post Implantation

Abstract Background Cardiac resynchronization therapy (CRT) is proved as an effective treatment for moderate to severe heart failure. It reduces all-cause mortality in patients with advanced heart failure. There is strong evidence that CRT reduces mortality and hospitalization, improves cardiac function and structure in symptomatic chronic heart failure patients with optimal medical treatment, severely depressed LVEF (i.e. &lt;35%) and complete LBBB. However 30% of patients may show negative response to CRT therapy. Therefore, optimization of CRT therapy in patients with heart failure seems to be a main subject for study in our researches. Methods of optimization includes optimization of medical therapy, control of risk factors and comorbidities, and optimization of device implantation and programming. Overall, studying the correlation between QRS duration and cardiac output will improve CRT programming optimization techniques. Aim To study the correlation between QRS duration and cardiac output measured by left ventricular outflow tract (LVOT) VTI in patients with CRT implantation. Methods Study included 100 CRT already implanted patients, they are requested to do a simple electrocardiographic and echocardiographic study. The relation between post implant QRS and cardiac output are studied among the patients. Results There was negative significant correlation between QRS duration and LVOT VTI and SVi. The optimal cut off values for optimal response to CRT using ROC curves were 130msec for post implant QRS duration and 17.1 cm for LVOT VTI. Conclusion CRT response is more in female patients with lower BSA, and without previous history of IHD or smoking. There is a significant negative correlation between QRS duration and LVOT VTI. Post implantation cut off value of QRS duration (&lt;130) predict higher LVOT VTI and also the post implantation benefit for the patient with CRT implanted.

P5973Regional left ventricular myocardial work and response to cardiac resynchronization therapy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M V Kostyukevich ◽  
P Van Der Bijl ◽  
N M Vo ◽  
N Ajmone Marsan ◽  
V Delgado ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Speckle Tracking ◽  
Multivariable Analysis ◽  
Lateral Wall ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Constructive Work ◽  
Crt Response

Abstract Background Myocardial work, assessed by speckle tracking echocardiography, reflects mechanical efficiency of the left ventricle. In heart failure patients, characterization of acute changes in regional (septal and lateral) left ventricular (LV) myocardial walls after cardiac resynchronization therapy (CRT) may enhance understanding of CRT response. Objective To evaluate the interaction between CRT response and components of myocardial work of the lateral wall and septum in patients with heart failure. Methods Regional LV myocardial work was calculated by integrating non-invasive blood pressure measurements, timing of mitral and aortic valve opening and closure and speckle tracking-derived LV longitudinal strain. From pressure-strain loops, constructive work (CW) and wasted work (WW) were calculated. CRT response was defined as a decrease in LV end-systolic volume ≥15% at 6 months follow-up. Changes in CW and WW of the septal and lateral walls prior to (baseline) and within the first 5 days after CRT implantation were compared between CRT responders and non-responders. Results At baseline, measurement of regional CW and WW was performed in 168 patients treated with CRT (71% men, 66±10 years). At 6 months, 59% of patients were CRT responders. CRT responders more frequently had non-ischemic heart failure than non-responders (54% vs 36%; p=0.027). At baseline, CRT responders were characterized by a significantly higher septal WW (270.5 [160.0; 451.5] mmHg% vs. 210.5 [106.3; 336.5] mmHg%; p=0.038) and lateral CW (989.5 [574.0; 1439.0] mmHg% vs. 689.0 [463,3; 1140.0] mmHg%; p=0.005). On multivariable analysis, only CW of the lateral wall at baseline was independently associated with CRT response (HR 1.001; 95% CI, 1.000–1.001; p=0.048). Immediately after CRT implantation, measurement of regional CW and WW was feasible in 115 patients. CRT responders showed improvement in CW (433.0 [254.5; 686.5] mmHg% to 664.5 [424.5; 977.8] mmHg%; p<0.001) and WW (305.0 [169.0; 461.3] mmHg% to 145.0 [80.0; 306.3] mmHg%; p=0.005) of the septum whereas the lateral wall demonstrated a significant decrease in CW (1036.5 [561.0; 1402.0] to 818.0 [491.0; 1154.3] mmHg%; p=0.005) and increase in WW (132.5 [80.3; 269.3] to 198.5 [107.5; 331.0] mmHg%; p=0.025). Non-responders showed only a decrease in WW of the septum (202.8 [102.9; 332.5] to 168.5 [67.6; 258.4] mmHg%; p=0.049). Conclusion CRT responders are characterized by increased WW of the septum and CW of the lateral wall at baseline, which are corrected immediately after CRT implantation. Constructive work of the LV lateral wall at baseline is independently associated with CRT response. Acknowledgement/Funding Study was supported by ESC Research grant 2018

The relationship between cardiac resynchronization therapy and serum levels of copeptin in patients with chronic heart failure

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
M Kerekanic ◽  
M Hudak ◽  
M Jakubova ◽  
D Kucerova ◽  
S Misikova ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Systolic Dysfunction ◽  
Serum Levels ◽  
Left Ventricular ◽  
Public Institution ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Crt Response

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): The present study was supported by a grant from Slovak Hearth Rhythm Association (Prognostic value of MR-proANP and MR-proADM in patients undergoing cardiac resynchronization therapy). Background Chronic heart failure (CHF) is a complex syndrome characterized by an abnormal neurohormonal activation, including arginine vasopressin (AVP). Copeptin is an indicator of AVP activation, which levels are elevated in CHF and have prognostic importance. Cardiac resynchronization therapy (CRT) is an important device therapy for patients with advanced CHF, left ventricular (LV) systolic dysfunction and evidence of electromechanical dyssynchrony. The aim of the present study was to determine the possible relationship between CRT and serum copeptin levels. Methods We have included CRT patients with ischemic as well as nonischemic etiology of CHF. The levels of copeptin were measured at baseline and 12 months respectively after CRT implantation. Echocardiography was also performed pre and 12 months post CRT implantation. A CRT response was defined as a ≥ 15 % reduction in LV end-systolic volume (LVESV). Results The study population consisted of 41 patients. The mean copeptin level was 20.50 ± 15.77 pmol/l. Copeptin levels positively correlated with New York Heart Association class, left atrial diameter, creatinine levels and NT-proBNP levels. CRT responders have significant reduction in copeptin levels from baseline to 12 months (from 16.96 ± 12.80 pmol/l to 6.20 ± 6.44 pmol/l, p &lt; 0.001). No significant changes in copeptin levels were observed in CRT nonresponders. Reduction &gt; 45 % in copeptin levels was predictor of CRT-response (OR 6.72, 95 % CI 1.01 - 18.11, p = 0.045). Conclusion The copeptin serum levels can be a useful biomarker in the evaluation of the CRT response.

P602Septal function and viability determine response to cardiac resynchronization therapy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Aalen ◽  
E Donal ◽  
C K Larsen ◽  
J Duchenne ◽  
E Kongsgaard ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Qrs Duration ◽  
Auc Value ◽  
Lge Cmr ◽  
Crt Response

Abstract Introduction Cardiac resynchronization therapy (CRT) has evolved as an important treatment in patients with symptomatic heart failure, reduced left ventricular (LV) ejection fraction and wide QRS. However, as one third of patients do not benefit from the therapy, there is need for better selection criteria. Previous studies have shown an association between recovery of septal function and response to CRT. Purpose To test the hypothesis that septal dysfunction in the absence of scar predicts response to CRT. Methods In 121 patients undergoing CRT implantation according to current European Society of Cardiology guidelines, we performed speckle-tracking echocardiography and estimated LV pressure non-invasively based on a method recently innovated in our lab. Pressure-strain analysis was used to calculate myocardial work. Septal dysfunction with asymmetric LV workload was calculated as the difference between LV lateral wall and septal work. Late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) was performed to assess septal scar. CRT response was defined as ≥15% reduction of LV end systolic volume by echocardiography at 6 months follow-up. Results Eighty-eight patients (73%) responded to CRT at 6 months follow-up. Multivariate logistic regression analysis including lateral-to-septal work difference, septal scar, QRS duration and QRS morphology found that only lateral-to-septal work difference and septal scar were significant predictors of CRT response (both p<0.005). Using logistic regression and receiver operating characteristic (ROC) curve analysis, we found that the combined approach of these two parameters identified CRT responders with a sensitivity of 86% and a specificity of 82%. The area under the curve (AUC) for CRT response prediction was 0.85 (95% CI: 0.76–0.94) (Figure). In comparison, the AUC value for QRS duration was 0.63 (95% CI: 0.52–0.75). Furthermore, for the subgroup of patients with QRS duration 120–150 ms (n=27), the AUC value for lateral-to-septal work difference in combination with septal scar was 0.90 (95% CI: 0.78–1.00). Conclusions A multimodality approach with strain echocardiography and LGE-CMR was able to detect CRT responders with high accuracy, also in the subset of patients with intermediate QRS duration. A dysfunctional but viable septum appears to be an ideal target for CRT.

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