Cardiac resynchronization therapy guided by late gadolinium-enhancement cardiovascular magnetic resonance

Journal of Cardiovascular Magnetic Resonance

Research

Russell EA Smith¹  Francisco Leyva¹  Shajil Chalil¹  Paul WX Foley²  Karim Ratib²  Frits Prinzen³  Angelo Auricchio⁴ 

[1] Centre for Cardiovascular Sciences, Queen Elizabeth Hospital, University of Birmingham, UK;Department of Cardiology, Good Hope Hospital, University of Birmingham, Sutton Coldfield, UK;Departments of Physiology and Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands;Fondazione Cardiocentro Ticino, Lugano, Switzerland;

关键词: Cardiovascular Magnetic Resonance;    Sudden Cardiac Death;    Cardiac Resynchronization Therapy;    Late Gadolinium Enhancement;    Cardiovascular Death;   

DOI  :  10.1186/1532-429X-13-29

 received in 2010-09-08, accepted in 2011-06-13,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundMyocardial scarring at the LV pacing site leads to incomplete resynchronization and a suboptimal symptomatic response to CRT. We sought to determine whether the use of late gadolinium cardiovascular magnetic resonance (LGE-CMR) to guide left ventricular (LV) lead deployment influences the long-term outcome of cardiac resynchronization therapy (CRT).Methods559 patients with heart failure (age 70.4 ± 10.7 yrs [mean ± SD]) due to ischemic or non-ischemic cardiomyopathy underwent CRT. Implantations were either guided (+CMR) or not guided (-CMR) by LGE-CMR prior to implantation. Fluoroscopy and LGE-CMR were used to localize the LV lead tip and and myocardial scarring retrospectively. Clinical events were assessed in three groups: +CMR and pacing scar (+CMR+S); CMR and not pacing scar (+CMR-S), and; LV pacing not guided by CMR (-CMR).ResultsOver a maximum follow-up of 9.1 yrs, +CMR+S had the highest risk of cardiovascular death (HR: 6.34), cardiovascular death or hospitalizations for heart failure (HR: 5.57) and death from any cause or hospitalizations for major adverse cardiovascular events (HR: 4.74) (all P < 0.0001), compared with +CMR-S. An intermediate risk of meeting these endpoints was observed for -CMR, with HRs of 1.51 (P = 0.0726), 1.61 (P = 0.0169) and 1.87 (p = 0.0005), respectively. The +CMR+S group had the highest risk of death from pump failure (HR: 5.40, p < 0.0001) and sudden cardiac death (HR: 4.40, p = 0.0218), in relation to the +CMR-S group.ConclusionsCompared with a conventional implantation approach, the use of LGE-CMR to guide LV lead deployment away from scarred myocardium results in a better clinical outcome after CRT. Pacing scarred myocardium was associated with the worst outcome, in terms of both pump failure and sudden cardiac death.

【 授权许可】

CC BY   
© Leyva et al; licensee BioMed Central Ltd. 2011