Journal of Cardiovascular Magnetic Resonance | |
Cardiac resynchronization therapy guided by late gadolinium-enhancement 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
【 预 览 】
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