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European Heart Journal Advance Access originally published online on July 4, 2009
European Heart Journal 2009 30(19):2360-2367; doi:10.1093/eurheartj/ehp280
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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

Magnetic resonance imaging and response to cardiac resynchronization therapy: relative merits of left ventricular dyssynchrony and scar tissue

Nina Ajmone Marsan1,2,6, Jos J.M. Westenberg3, Claudia Ypenburg1, Rutger J. van Bommel1, Stijntje Roes4, Victoria Delgado1, Laurens F. Tops1, Rob J. van der Geest3, Eric Boersma5, Albert de Roos4, Martin J. Schalij1 and Jeroen J. Bax1,*

1 Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
2 Department of Cardiology, IRCCS Policlinico S. Matteo, Pavia, Italy
3 Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
4 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
5 Department of Epidemiology and Statistics, Erasmus University, Rotterdam, The Netherlands
6 Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands

Received 2 December 2008; revised 4 March 2009; accepted 11 June 2009; online publish-ahead-of-print 4 July 2009.

* Corresponding author. Tel: +31 71 526 2020, Fax: +31 71 526 6809, Email: j.j.bax{at}lumc.nl

Aim: To assess the relative value of a novel measure of left ventricular (LV) dyssynchrony derived from magnetic resonance imaging (MRI) and the extent of scar tissue for prediction of response to cardiac resynchronization therapy (CRT).

Methods and results: Thirty-five heart failure patients scheduled for CRT were included. Left ventricular dyssynchrony was defined as the standard deviation of 16 segment time-to-maximum radial wall thickness (SDt-16) obtained from a cine-set of short-axis slices. Delayed-enhanced MRI was performed for scar analysis. Echocardiography was used to determine response to CRT (reduction ≥15% in LV end-systolic volume 6 months after implantation). At follow-up, 21 patients (60%) were classified as responders. On MRI, SDt-16 was significantly higher in responders compared with non-responders (median 97 vs. 60 ms, P < 0.001), whereas the total extent of scar was larger in non-responders (median 35% vs. 3% in responders, P < 0.001). At the logistic regression analysis, SDt-16 was directly associated (OR = 6.3, 95% CI 3.1–9.9, P < 0.001) and the total extent of scar was inversely associated (OR = 0.52, 95% CI 0.43–0.87, P < 0.001) with response to CRT.

Conclusion: Magnetic resonance imaging offers the unique opportunity to assess LV dyssynchrony and scar extent in a single session. Both these parameters are important predictors of echocardiographic response to CRT.

Key Words: Magnetic resonance imaging • Cardiac resynchronization therapy • Left ventricular dyssynchrony • Myocardial scar


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