Prediction of response to cardiac resynchronization therapy using left ventricular pacing lead position and cardiovascular magnetic resonance derived wall motion patterns: a prospective cohort study

Journal of Cardiovascular Magnetic Resonance

Research

Jonathan D. Suever¹  R. Patrick Magrath¹  Patrick T. Strickland²  Nima Ghasemzadeh²  Michael H. Hoskins²  Ankit Parikh²  Angel R. Leon²  Michael S. Lloyd²  Stephanie Clement-Guinaudeau³  John N. Oshinski⁴  Gregory R. Hartlage⁵  Stamatios Lerakis⁵ 

[1] Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA, USA;Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA;Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA;Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA;Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA, USA;Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA;Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA;

关键词: Cardiovascular magnetic resonance;    Dyssynchrony;    Cardiac resynchronization therapy;   

DOI  :  10.1186/s12968-015-0158-5

 received in 2014-10-31, accepted in 2015-06-22,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundDespite marked benefits in many heart failure patients, a considerable proportion of patients treated with cardiac resynchronization therapy (CRT) fail to respond appropriately. Recently, a “U-shaped” (type II) wall motion pattern identified by cardiovascular magnetic resonance (CMR) has been associated with improved CRT response compared to a homogenous (type I) wall motion pattern. There is also evidence that a left ventricular (LV) lead localized to the latest contracting LV site predicts superior response, compared to an LV lead localized remotely from the latest contracting LV site.MethodsWe prospectively evaluated patients undergoing CRT with pre-procedural CMR to determine the presence of type I and type II wall motion patterns and pre-procedural echocardiography to determine end systolic volume (ESV). We assessed the final LV lead position on post-procedural fluoroscopic images to determine whether the lead was positioned concordant to or remote from the latest contracting LV site. CRT response was defined as a ≥ 15 % reduction in ESV on a 6 month follow-up echocardiogram.ResultsThe study included 33 patients meeting conventional indications for CRT with a mean New York Heart Association class of 2.8 ± 0.4 and mean LV ejection fraction of 28 ± 9 %. Overall, 55 % of patients were echocardiographic responders by ESV criteria. Patients with both a type II pattern and an LV lead concordant to the latest contracting site (T2CL) had a response rate of 92 %, compared to a response rate of 33 % for those without T2CL (p = 0.003). T2CL was the only independent predictor of response on multivariate analysis (odds ratio 18, 95 % confidence interval 1.6-206; p = 0.018). T2CL resulted in significant incremental improvement in prediction of echocardiographic response (increase in the area under the receiver operator curve from 0.69 to 0.84; p = 0.038).ConclusionsThe presence of a type II wall motion pattern on CMR and a concordant LV lead predicts superior CRT response. Improving patient selection by evaluating wall motion pattern and targeting LV lead placement may ultimately improve the response rate to CRT.

【 授权许可】

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© Hartlage et al. 2015. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.