Cardiac Magnetic Resonance Assessment of Dyssynchrony and Myocardial Scar Predicts Function Class Improvement Following Cardiac Resynchronization Therapy

JACC-CARDIOVASCULAR IMAGING

卷:1

Article

Bluemke, David A.⁴  Halperin, Henry R.^2,4  Kass, David A.^2,3  Lardo, Albert C.^1,2,3 

[1] Johns Hopkins Sch Med, Image Guided Cardiotherapy Lab, Div Cardiol, Dept Med, Baltimore, MD 21205 USA

[2] Johns Hopkins Sch Med, Dept Biomed Engn, Baltimore, MD 21205 USA

[3] Johns Hopkins Sch Med, Dept Surg, Baltimore, MD 21205 USA

[4] Johns Hopkins Sch Med, Dept Radiol, Baltimore, MD 21205 USA

关键词: cardiac magnetic resonance;    cardiac resynchronization therapy;    biventricular dyssynchrony;    heart failure;   

DOI  :  10.1016/j.jcmg.2008.04.013

来源: Elsevier

【 摘 要 】

OBJECTIVES We tested a circumferential mechanical dyssynchrony index (circumferential uniformity ratio estimate [CURE]; 0 to 1, 1 = synchrony) derived from magnetic resonance-myocardial tagging (MR-MT) for predicting clinical function class improvement following cardiac resynchronization therapy (CRT). BACKGROUND There remains a significant nonresponse rate to CRT. MR-MT provides high quality mechanical activation data throughout the heart, and delayed enhancement cardiac magnetic resonance (DE-CMR) offers precise characterization of myocardial scar. METHODS MR-MT was performed in 2 cohorts of heart failure patients with: 1) a CRT heart failure cohort (n = 20; left ventricular ejection fraction of 0.23 +/- 0.057) to evaluate the role of MR-MT and DE-CMR prior to CRT; and 2) a multimodality cohort (n = 27; ejection fraction of 0.20 +/- 0.066) to compare MR-MT and tissue Doppler imaging septal-lateral delay for assessment of mechanical dyssynchrony. MR-MT was also performed in 9 healthy control subjects. RESULTS MR-MT showed that control subjects had highly synchronous contraction (CURE 0.96 +/- 0.01), but tissue Doppler imaging indicated dyssynchrony in 44%. Using a cutoff of <0.75 for CURE based on receiver-operator characteristic analysis (area under the curve: 0.889), 56% of patients tested positive for mechanical dyssynchrony, and the MR-MT CURE predicted improved function class with 90% accuracy (positive and predictive values: 87%, 100%); adding DE-CMR (% total scar <15%) data improved accuracy further to 95% (positive and negative predictive values: 93%, 100%). The correlation between CURE and QRS duration was modest in all cardiomyopathy subjects (r = 0.58, p < 0.001). The multimodality cohort showed a 30% discordance rate between CURE and tissue Doppler imaging septal-lateral delay. CONCLUSIONS The MR-MT assessment of circumferential mechanical dyssynchrony predicts improvement in function class after CRT. The addition of scar imaging by DE-CMR further improves this predictive value. (J Am Coll Cardiol Img 2008; 1: 561-8) (C) 2008 by the American College of Cardiology Foundation

【 授权许可】

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