Cardiac Magnetic Resonance Assessment of Response to Cardiac Resynchronization Therapy and Programming Strategies

JACC-CARDIOVASCULAR IMAGING

卷:14

Article

Gao, Xu¹  Abdi, Mohamad²  Auger, Daniel A.²  Sun, Changyu²  Hanson, Christopher A.¹  Robinson, Austin A.¹  Schumann, Christopher¹  Oomen, Pim J.²  Ratcliffe, Sarah³  Malhotra, Rohit¹  Darby, Andrew¹  Monfredi, Oliver J.¹  Mangrum, J. Michael¹  Mason, Pamela¹  Mazimba, Sula¹  Holmes, Jeffrey W.²  Kramer, Christopher M.⁴  Epstein, Frederick H.^2,4  Salerno, Michael^2,4  Bilchick, Kenneth C.¹ 

[1] Univ Virginia Hlth Syst, Dept Med, Charlottesville, VA USA

[2] Univ Virginia Hlth Syst, Dept Biomed Engn, Charlottesville, VA USA

[3] Univ Virginia Hlth Syst, Dept Publ Hlth Sci, Charlottesville, VA USA

[4] Univ Virginia Hlth Syst, Dept Radiol & Med Imaging, Charlottesville, VA USA

关键词: heart failure;    implantable cardioverter-defibrillator;    cardiac magnetic resonance;    cardiac resynchronization therapy;   

DOI  :  10.1016/j.jcmg.2021.06.015

来源: Elsevier

【 摘 要 】

OBJECTIVES The objective was to determine the feasibility and effectiveness of cardiac magnetic resonance (CMR) cine and strain imaging before and after cardiac resynchronization therapy (CRT) for assessment of response and the optimal resynchronization pacing strategy. BACKGROUND CMR with cardiac implantable electronic devices can safely provide high-quality right ventricular/left ventricular (LV) ejection fraction (RVEF/LVEF) assessments and strain. METHODS CMR with cine imaging, displacement encoding with stimulated echoes for the circumferential uniformity ratio estimate with singular value decomposition (CURE-SVD) dyssynchrony parameter, and scar assessment was performed before and after CRT. Whereas the pre-CRT scan constituted a single imaging set with complete volumetric, strain, and scar imaging, multiple imaging sets with complete strain and volumetric data were obtained during the post CRT scan for biventricular pacing (BIVP), LV pacing (LVP), and asynchronous atrial pacing modes by reprogramming the device outside the scanner between imaging sets. RESULTS 100 CMRs with a total of 162 imaging sets were performed in 50 patients (median age 70 years [IQR: 50-86 years]; 48% female). Reduction in LV end-diastolic volumes (P = 0.002) independent of CRT pacing were more prominent than corresponding reductions in right ventricular end-diastolic volumes (P = 0.16). A clear dependence of the optimal CRT pacing mode (BIVP vs LVP) on the PR interval (P = 0.0006) was demonstrated. The LVEF and RVEF improved more with BIVP than LVP with PR intervals $240 milliseconds (P = 0.025 and P = 0.002, respectively); the optimal mode (BIVP vs LVP) was variable with PR intervals <240 milliseconds. A lower pre-CRT displacement encoding with stimulated echoes (DENSE) CURE-SVD was associated with greater improvements in the post-CRT CURE-SVD (r =-0.69; P < 0.001), LV end-systolic volume (r =-0.58; P < 0.001), and LVEF (r =-0.52; P < 0.001). CONCLUSIONS CMR evaluation with assessment of multiple pacing modes during a single scan after CRT is feasible and provides useful information for patient care with respect to response and the optimal pacing strategy. (J Am Coll Cardiol Img 2021;14:2369-2383) (c) 2021 by the American College of Cardiology Foundation.

【 授权许可】

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