Effect of Posterolateral Left Ventricular Scar on Mortality and Morbidity following Cardiac Resynchronization Therapy

Chalil, Shajil; Stegemann, Berthold; Muhyaldeen, S; Khadjooi, Kayvan; Foley, Paul; Smith, Rea; Leyva, Francisco

doi:10.1111/j.1540-8159.2007.00841.x

Cited by 123 publications

(85 citation statements)

References 30 publications

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“…Moreover they failed to improve clinically, in terms of NYHA class, exercise capacity, and quality of life. Similarly, Chalil et al (31) showed that pacing scarred LV myocardium carries greater risk of mortality and morbidity than pacing nonscarred myocardium, detected by LGE-CMR. Consequently, all these findings suggest a substantial influence of regional viability and LV pacing site on clinical response to CRT.…”

Section: Interventricular Dysynchronymentioning

confidence: 95%

Selection of candidates for cardiac resynchronization therapy: late gadolinium enhanced cardiac magnetic resonance as a new and promising predictor of intraventricular dyssynchrony

Gürel¹,

Tigen²

2011

Anadolu Kardiyol Derg

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ÖZETKardiyak resenkronizasyon tedavisi (KRT) ventrikül içi ileti gecikmesi olan hastalar için önemli bir tedavi seçeneği olup, seçilmiş kalp yetmezliği hastalarında mortalite ve morbiditeyi azalttığı gösterilmiştir. Ventrikül içi gecikmeyi tanımlamak ve KRT adaylarını seçmek için, renkli doku Doppler ekokardiyografi ve benek takibi gibi, çeşitli ekokardiyografik yöntemler önerilmiştir. Bu dikkatlice seçilmiş hastaların yaklaşık %30'u yanıt vermediğine göre, KRT'ne yanıtın öngörücüleri hala araştırma konusu olarak kalmaya devam etmektedir. Son zamanlarda kardiyak manyetik rezonans (KMR) görüntülemelerdeki geç gadolinyum tutulumu tarafından gösterilen miyokardiyal fibrozis, hem intraventriküler dissenkroninin hem de KRT'ne cevabın gelecek vadeden öngörücüsü olarak gösterilmiştir. Bu derlemenin konusu, KRT adaylarını seçmede kullanılan majör ekokardiyografik yön-temler, bu konuda KMR tarafından saptanan kardiyak fibrozisin potansiyel rolü ve kardiyak fibrozisin intraventriküler dissenkroni varlığıyla muhtemel ilişkisidir. ( ABSTRACTCardiac resynchronization therapy (CRT) is an important therapeutic option for patients with intraventricular conduction delay and has been shown to reduce mortality and morbidity in selected heart failure patients. Several echocardiographic methods have been proposed to define intraventricular delay and to select candidates for CRT, such as color coded tissue Doppler echocardiography and speckle tracking. Since, up to 30% of these carefully selected patients do not receive benefit; predictors of response to CRT still remain a topic of ongoing investigations. Recently, myocardial fibrosis defined by late gadolinium enhancement on cardiac magnetic resonance (CMR) imaging has been introduced as promising predictor of both intraventricular dyssynchrony and response to CRT. The focus of the present review is the major echocardiographic modalities to select CRT candidates, the potential role of cardiac fibrosis detected by CMR in this respect, and the possible relation of it with the presence of intraventricular dyssynchrony.

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Section: Interventricular Dysynchronymentioning

confidence: 95%

Selection of candidates for cardiac resynchronization therapy: late gadolinium enhanced cardiac magnetic resonance as a new and promising predictor of intraventricular dyssynchrony

Gürel¹,

Tigen²

2011

Anadolu Kardiyol Derg

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“…This delay in LV activation results in less hemodynamic improvement during BiV pacing [52]. Electrical stimulation in regions of scar can also be pro-arrhythmic [53,54] and is associated with increased morbidity and mortality [8,55]. Unsurprisingly, the presence of myocardial scar at the site of LV stimulation during CRT is associated with non-response [8,56].…”

Section: Tissue Characterizationmentioning

confidence: 99%

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Sieniewicz

Gould

Porter

et al. 2018

Expert Review of Medical Devices

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Introduction: Cardiac resynchronization therapy (CRT) has emerged as one of the few effective treatments for heart failure. However, up to 50% of patients derive no benefit. Suboptimal left ventricle (LV) lead position is a potential cause of poor outcomes while targeted lead deployment has been associated with enhanced response rates. Image-fusion guidance systems represent a novel approach to CRT delivery, allowing physicians to both accurately track and target a specific location during LV lead deployment.Areas covered: This review will provide a comprehensive evaluation of how to define the optimal pacing site. We will evaluate the evidence for delivering targeted LV stimulation at sites displaying favorable viability or advantageous mechanical or electrical properties. Finally, we will evaluate several emerging image-fusion guidance systems which aim to facilitate optimal site selection during CRT.Expert commentary: Targeted LV lead deployment is associated with reductions in morbidity and mortality. Assessment of tissue characterization and electrical latency are critical and can be achieved in a number of ways. Ultimately, the constraints of coronary sinus anatomy have forced the exploration of novel means of delivering CRT including endocardial pacing which hold promise for the future of CRT delivery.

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“…There are previous studies demonstrating that posterolateral (17 ) or lateral (18) scar locations correlate with worse CRT response. In addition, Riedlbauchová et al (6) endeavored to determine the LV lead position based on chest radiographs in 2 different views, with translation into a 17-segment model of the left ventricle.…”

Section: Discussion Scar Burden and LV Lead Positionmentioning

confidence: 98%

Electrocardiogram-Gated ¹⁸F-FDG PET/CT Hybrid Imaging in Patients with Unsatisfactory Response to Cardiac Resynchronization Therapy: Initial Clinical Results

Uebleis

Ulbrich²,

Tegtmeyer³

et al. 2010

J Nucl Med

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The present study aimed to distinguish responders to cardiac resynchronization therapy (CRT ) from nonresponders, using electrocardiogram-gated 18 F-FDG PET/CT. Methods: Seven consecutive CRT nonresponders were included in the study, along with 7 age-and sex-matched CRT responders, serving as reference material. Therapy response was defined as clinical improvement ($1 New York Heart Association class) and evidence of reverse remodeling. Besides PET/CT, we measured brain natriuretic peptide levels and assessed dyssynchrony using transthoracic echocardiography. Results: Compared with nonresponders, CRT responders showed significant differences in the declines of left-ventricular end-systolic volume and brain natriuretic peptide and in left-ventricular dyssynchrony (global left-ventricular entropy), extent of the myocardial scar burden, and biventricular pacemaker leads positioned within viable myocardial regions. Among the nonresponders, further therapy management was guided by the PET/CT results in 4 of 7 patients. Conclusion: Cardiac hybrid imaging using gated 18 F-FDG PET/CT enabled the identification of potential reasons for nonresponse to CRT therapy, which can guide subsequent therapy.

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Effect of Posterolateral Left Ventricular Scar on Mortality and Morbidity following Cardiac Resynchronization Therapy

Abstract: A PL scar is associated with a worse clinical outcome following CRT, particularly if it is transmural. Pacing scarred left ventricular myocardium carries a greater risk of mortality and morbidity than pacing nonscarred myocardium.

Cited by 123 publications

References 30 publications

Selection of candidates for cardiac resynchronization therapy: late gadolinium enhanced cardiac magnetic resonance as a new and promising predictor of intraventricular dyssynchrony

Selection of candidates for cardiac resynchronization therapy: late gadolinium enhanced cardiac magnetic resonance as a new and promising predictor of intraventricular dyssynchrony

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Electrocardiogram-Gated ¹⁸F-FDG PET/CT Hybrid Imaging in Patients with Unsatisfactory Response to Cardiac Resynchronization Therapy: Initial Clinical Results

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Effect of Posterolateral Left Ventricular Scar on Mortality and Morbidity following Cardiac Resynchronization Therapy

Abstract: A PL scar is associated with a worse clinical outcome following CRT, particularly if it is transmural. Pacing scarred left ventricular myocardium carries a greater risk of mortality and morbidity than pacing nonscarred myocardium.

Cited by 123 publications

References 30 publications

Selection of candidates for cardiac resynchronization therapy: late gadolinium enhanced cardiac magnetic resonance as a new and promising predictor of intraventricular dyssynchrony

Selection of candidates for cardiac resynchronization therapy: late gadolinium enhanced cardiac magnetic resonance as a new and promising predictor of intraventricular dyssynchrony

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Electrocardiogram-Gated 18F-FDG PET/CT Hybrid Imaging in Patients with Unsatisfactory Response to Cardiac Resynchronization Therapy: Initial Clinical Results

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Product

Resources

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Electrocardiogram-Gated ¹⁸F-FDG PET/CT Hybrid Imaging in Patients with Unsatisfactory Response to Cardiac Resynchronization Therapy: Initial Clinical Results