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European Heart Journal Advance Access published online on May 28, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp212
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Left ventricular dyssynchrony in patients with left bundle branch block and patients after myocardial infarction: integration of mechanics and viability by cardiac magnetic resonance

Andrea K. Rutz1,{dagger}, Robert Manka1,2,{dagger}, Sebastian Kozerke1, Susanne Roas3, Peter Boesiger1 and Juerg Schwitter3,*

1 Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
2 Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Berlin, Germany
3 Clinic of Cardiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland

Received 12 August 2008; revised 4 May 2009; accepted 7 May 2009 * Corresponding author. University Hospital Lausanne – CHUV, Cardiology, Switzerland. Tel: +41 21 314 0015, Secretariat: +41 21 314 0010, Fax: +41 21 314 0013, Email: jurg.schwitter{at}chuv.ch

Aims: To quantify left ventricular (LV) dyssynchrony in patients with left bundle branch block (LBBB) and in patients after myocardial infarction (MI) applying an accelerated three-dimensional (3D) tagging cardiac magnetic resonance (CMR) technique, and to combine dyssynchrony information with viability data obtained by late gadolinium enhancement (LGE) CMR.

Methods and results: Thirty-two patients (59 ± 11 years) after first MI (PatsMI), 10 patients (63 ± 10 years) with LBBB (ejection fraction < 40%; PatsLBBB<40), 13 patients (63 ± 11) with LBBB (ejection fraction ≥ 40%; PatsLBBB≥40), and 15 healthy controls (53 ± 10 years) underwent 3D tagging CMR and LGE imaging at 1.5 T. As a measure of mechanical LV dyssynchrony, the standard deviation of Tmax over the LV, the circumferential uniformity ratio estimate (CURE) index, and a segmental-based circumferential systolic dyssynchrony index (SDI) were calculated. All three parameters detected significantly increased circumferential dyssynchrony in patients compared with controls. The CURE and SDI showed a good correlation (r = 0.93, P < 0.0001) and detected most severe dyssynchrony in PatsLBBB<40 (P < 0.001 vs. controls, P < 0.005 vs. PatsMI). Systolic dyssynchrony index additionally allowed integration of localized viability information to yield SDIviable which was highest in PatsLBBB<40.

Conclusion: Dyssynchrony patterns in the LV can be quantified globally and regionally by 3D tagging CMR. Combination of viability and dyssynchrony information allows for a comprehensive dyssynchrony quantification in patients with LBBB or post-MI. Future studies are required to test the value of the method to predict responsiveness to resynchronization.

Key Words: Magnetic resonance imaging • Tagging • Myocardial infarction • Left bundle branch block • Dyssynchrony • Cardiac resynchronization therapy

{dagger} The first two authors contributed equally to the study.


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