Purpose
In heart failure (HF) patients,
cardiac resynchronization therapy (CRT) has beneficial effects on symptoms,
left ventricular (LV) systolic function and survival.
In ischemic HF patients non-response rate to CRT is higher as compared to non-ischemic HF patients.
The aim of the study was to explore the role of late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) and 2D-speckle tracking echocardiography to guide CRT implantation in ischemic HF patients.
Methods and Materials
A total of 90 ischemic HF patients were included and divided in 2 groups.
Group 1: 30 patients undergone to LGE-CMR and 2D-speckle tracking echocardiography at baseline.
Scar transmurality was assessed on LGE-CMR images using a 17-segment model.
A transmural scar was defined as having >50% of the thickness in any of these 17 segments.
As a consequence,
a viable segment was defined when scar tissue was < 51% of its thickness.
From 2D-speckle tracking echocardiography was derived global longitudinal strain bulls eye of time...
Results
The mean age was 64±11 years,
62 men.
Baseline characteristic were not different between the two study groups.
Interestingly response rate to CRT was significantly higher in group 1 as
compared to group 2 (73% vs.
52%,
p = 0.045).
Conclusion
LGE-CMR together with 2D-speckle tracking echocardiography are important tools to guide CRT implantation in ischemic HF patients in order to improve response rate to CRT.
References
Assomull RG,
Pennell DJ,
Prasad SK.
Cardiovascular magnetic resonance in the evaluation of heart failure.
Heart 2007;93;985-992
Abdel-Aty H,
Zagrosek A,
Schulz-Menger J,
et al.
Delayed enhancement and T2-weighted cardiovascular magnetic resonance imaging differentiate acute from chronic myocardial infarction.
Circulation 2004;109:2411–2416
Kim RJ,
Fieno DS,
Parrish TB,
et al.
Relationship of MRI delayed contrast enhancement to irreversible injury,
infarct age,
and contractile function.
Circulation 1999;100:1992–2002
Oshinski JN,
Yang Z,
Jones JR,
et al.
Imaging time after Gd-DTPA injection is critical in using delayed enhancement to...