A prospective evaluation of cardiovascular magnetic resonance measures of dyssynchrony in the prediction of response to cardiac resynchronization therapy

Journal of Cardiovascular Magnetic Resonance

Research

Wenzhe Shi¹  Daniel Rueckert¹  Xiahai Zhuang²  Sebastien Ourselin²  Sebastian Kozerke³  Matthew Ginks³  Simon G Duckett³  Eva Sammut³  Steven Niederer³  Reza Razavi³  Nic Smith³  Anoop Shetty⁴  Christopher Aldo Rinaldi⁴  Manav Sohal⁵  Gerald Carr-White⁶ 

[1] Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK;Centre for Medical Image Computing, University College London, London, UK;Division of Imaging Sciences and Biomedical Engineering, Kings College London, London, UK;Division of Imaging Sciences and Biomedical Engineering, Kings College London, London, UK;The Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK;Division of Imaging Sciences and Biomedical Engineering, Kings College London, London, UK;The Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK;Division of Imaging Sciences, The Rayne Institute, 4th Floor, Lambeth Wing, St Thomas’ Hospital, SE1 7EH, London, UK;The Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK;

关键词: Cardiac resynchronization therapy;    Cardiovascular magnetic resonance;    Dyssynchrony;    Heart failure;    Strain;    Regional volume-change SDI;   

DOI  :  10.1186/s12968-014-0058-0

 received in 2014-04-14, accepted in 2014-07-18,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundMany patients with electrical dyssynchrony who undergo cardiac resynchronization therapy (CRT) do not obtain substantial benefit. Assessing mechanical dyssynchrony may improve patient selection. Results from studies using echocardiographic imaging to measure dyssynchrony have ultimately proved disappointing. We sought to evaluate cardiac motion in patients with heart failure and electrical dyssynchrony using cardiovascular magnetic resonance (CMR). We developed a framework for comparing measures of myocardial mechanics and evaluated how well they predicted response to CRT.MethodsCMR was performed at 1.5 Tesla prior to CRT. Steady-state free precession (SSFP) cine images and complementary modulation of magnetization (CSPAMM) tagged cine images were acquired. Images were processed using a novel framework to extract regional ventricular volume-change, thickening and deformation fields (strain). A systolic dyssynchrony index (SDI) for all parameters within a 16-segment model of the ventricle was computed with high SDI denoting more dyssynchrony. Once identified, the optimal measure was applied to a second patient population to determine its utility as a predictor of CRT response compared to current accepted predictors (QRS duration, LBBB morphology and scar burden).ResultsForty-four patients were recruited in the first phase (91% male, 63.3 ± 14.1 years; 80% NYHA class III) with mean QRSd 154 ± 24 ms. Twenty-one out of 44 (48%) patients showed reverse remodelling (RR) with a decrease in end systolic volume (ESV) ≥ 15% at 6 months. Volume-change SDI was the strongest predictor of RR (PR 5.67; 95% CI 1.95-16.5; P = 0.003). SDI derived from myocardial strain was least predictive. Volume-change SDI was applied as a predictor of RR to a second population of 50 patients (70% male, mean age 68.6 ± 12.2 years, 76% NYHA class III) with mean QRSd 146 ± 21 ms. When compared to QRSd, LBBB morphology and scar burden, volume-change SDI was the only statistically significant predictor of RR in this group.ConclusionA systolic dyssynchrony index derived from volume-change is a highly reproducible measurement that can be derived from routinely acquired SSFP cine images and predicts RR following CRT whilst an SDI of regional strain does not.

【 授权许可】

CC BY   
© Sohal et al.; licensee BioMed Central 2014