Effect of Posterolateral Scar Tissue on Clinical and Echocardiographic Improvement After Cardiac Resynchronization Therapy

Bleeker, Gabe B.; Kaandorp, Theodorus A.M.; Lamb, Hildo J.; Boersma, Eric; Steendijk, Paul; Roos, Albert de; Wall, Ernst E. van der; Schalij, Martin J.; Bax, Jeroen J.

doi:10.1161/circulationaha.105.543678

Cited by 721 publications

(495 citation statements)

References 28 publications

Supporting

Mentioning

447

Contrasting

Unclassified

Order By: Relevance

“…This has become an active area of research in the CRT setting, with several subsequent studies documenting the value of scar burden, location and transmurality of myocardial infarctions as a predictor of response to CRT [20-24]. Consistent with this work, our study showed myocardial infarction and scar burden (as determined by percentage of LGE mass) to portend an adverse response to CRT.…”

Section: Discussionsupporting

confidence: 86%

Right ventricular dysfunction is a predictor of non-response and clinical outcome following cardiac resynchronization therapy

Alpendurada

Guha

Sharma

et al. 2011

Journal of Cardiovascular Magnetic Resonance

View full text Add to dashboard Cite

BackgroundCardiac resynchronization therapy (CRT) is an established treatment in advanced heart failure (HF). However, an important subset does not derive a significant benefit. Despite an established predictive role in HF, the significance of right ventricular (RV) dysfunction in predicting clinical benefit from CRT remains unclear. We investigated the role of RV function, assessed by cardiovascular magnetic resonance (CMR), in predicting response to and major adverse clinical events in HF patients undergoing CRT.MethodsSixty consecutive patients were evaluated with CMR prior to CRT implantation in a tertiary cardiac centre. The primary end-point was a composite of death from any cause or unplanned hospitalization for a major cardiovascular event. The secondary end-point was response to therapy, defined as improvement in left ventricular ejection fraction ≥ 5% on echocardiography at one year.ResultsEighteen patients (30%) met the primary end-point over a median follow-up period of 26 months, and 27 out of 56 patients (48%) were considered responders to CRT. On time-to-event analysis, only atrial fibrillation (HR 2.6, 95% CI 1.02-6.84, p = 0.047) and RV dysfunction, either by a reduced right ventricular ejection fraction-RVEF (HR 0.96, 95% CI 0.94-0.99, p = 0.006) or tricuspid annular plane systolic excursion-TAPSE (HR 0.88, 95% CI, 0.80-0.96, p = 0.006), were significant predictors of adverse events. On logistic regression analysis, preserved RVEF (OR 1.05, 95% CI 1.01-1.09, p = 0.01) and myocardial scar burden (OR 0.90, 95% CI 0.83-0.96, p = 0.004) were the sole independent predictors of response to CRT. Patients with marked RV dysfunction (RVEF < 30%) had a particularly low response rate (18.2%) to CRT.ConclusionsRight ventricular function is an important predictor of both response to CRT and long-term clinical outcome. Routine assessment of the right ventricle should be considered in the evaluation of patients for CRT.

show abstract

Section: Discussionsupporting

confidence: 86%

Right ventricular dysfunction is a predictor of non-response and clinical outcome following cardiac resynchronization therapy

Alpendurada

Guha

Sharma

et al. 2011

Journal of Cardiovascular Magnetic Resonance

View full text Add to dashboard Cite

show abstract

“…The location of scar is of equal importance, in particular when it is located in the posterolateral region of the LV, a site empirically thought to be optimal for LV lead deployment. Scar in this area is associated with lower response rates following CRT [45,48]. …”

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

View full text Add to dashboard Cite

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.

show abstract

“…All coronary vein images were obtained during the systolic rest period when coronary veins are maximally dilated (4). This optimal trigger time was visually determined using a breath-hold 2D cine SSFP image in two-chamber orientation with the following imaging parameters: TE ϭ 1.3 ms, TR ϭ 2.6 ms, ␣ ϭ 60°, field of view (FOV) of 320 ϫ 320 ϫ 8 mm 3 , spatial resolution of 2 ϫ 2 ϫ 8 mm 3 , a temporal resolution of 21 ms and a total duration of 10.2 s. The trigger time was then visually selected as the onset of the least-motion period in the cross-section of coronary sinus.…”

Section: Methodsmentioning

confidence: 99%

“…Additionally, knowledge of coronary vein anatomy in relation to the tissue characteristics of the underlying myocardium in the pacing sites could improve the efficacy of this therapy, thereby improving on the 30 -40% nonresponder rate (1,2). It has been shown recently that CRT does not reduce LV dyssynchrony in patients with transmural scar tissue in posterolateral LV segments, resulting in clinical nonresponse to CRT (3).…”

mentioning

confidence: 99%

Whole heart magnetization‐prepared steady‐state free precession coronary vein MRI

Stoeck

Han

Peters

et al. 2009

Magnetic Resonance Imaging

View full text Add to dashboard Cite

Purpose: To compare two coronary vein imaging techniques using whole-heart balanced steady-state free precession (SSFP) and a targeted double-oblique spoiled gradient-echo (GRE) sequences in combination with magnetization transfer (MT) preparation sequence for tissue contrast improvement. Materials and Methods:Nine healthy subjects were imaged with the proposed technique. The results are compared with optimized targeted MT prepared GRE acquisitions. Both quantitative and qualitative analyses were performed to evaluate each imaging method.Results: Whole-heart images were successfully acquired with no visible image artifact in the vicinity of the coronary veins. The anatomical features and visual grading of both techniques were comparable. However, the targeted small slab acquisition of the left ventricular lateral wall was superior to whole-heart acquisition for visualization of relevant information for cardiac resynchronization therapy (CRT) lead implantation. Conclusion:We demonstrated the feasibility of wholeheart coronary vein MRI using a 3D MT-SSFP imaging sequence. A targeted acquisition along the lateral left ventricular wall is preferred for visualization of branches commonly used in CRT lead implantation.

show abstract

Effect of Posterolateral Scar Tissue on Clinical and Echocardiographic Improvement After Cardiac Resynchronization Therapy

Cited by 721 publications

References 28 publications

Right ventricular dysfunction is a predictor of non-response and clinical outcome following cardiac resynchronization therapy

Right ventricular dysfunction is a predictor of non-response and clinical outcome following cardiac resynchronization therapy

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

Whole heart magnetization‐prepared steady‐state free precession coronary vein MRI

Contact Info

Product

Resources

About