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European Heart Journal Advance Access originally published online on November 22, 2006
European Heart Journal 2007 28(1):33-41; doi:10.1093/eurheartj/ehl379
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Impact of viability and scar tissue on response to cardiac resynchronization therapy in ischaemic heart failure patients

Claudia Ypenburg1, Martin J. Schalij1, Gabe B. Bleeker1, Paul Steendijk1, Eric Boersma2, Petra Dibbets-Schneider3, Marcel P.M. Stokkel3, Ernst E. van der Wall1 and Jeroen J. Bax1,*

1 Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
2 Department of Epidemiology and Statistics, Erasmus University, Rotterdam, the Netherlands
3 Department of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands

Received 17 July 2006; revised 4 October 2006; accepted 26 October 2006; online publish-ahead-of-print 22 November 2006.

* Corresponding author. Tel: +31 71 5262020; fax: +31 71 5266809. E-mail address: jbax{at}knoware.nl

Aims At present, 20–30% of patients do not respond to cardiac resynchronization therapy (CRT). In this study, the relation between the extent of viable myocardium and scar tissue vs. response to CRT was evaluated. In addition, the presence of scar tissue in the left ventricular (LV) lead position was specifically related to response to CRT.

Methods and results A total of 51 consecutive patients with ischaemic heart failure and substantial LV dyssynchrony undergoing CRT were included. All patients underwent gated SPECT before CRT implantation to determine the extent of scar tissue and viable myocardium. Clinical and echocardiographic parameters were assessed at baseline and after 6 months of CRT. The results demonstrated direct relations between the response to CRT and the extent of viable myocardium and scar tissue. In addition, the 15 patients (29%) with transmural scar tissue (< 50% tracer activity) in the region of the LV pacing lead showed no improvement after 6 months of CRT.

Conclusion The extent of scar tissue and viable myocardium were directly related to the response to CRT. Furthermore, scar tissue in the LV pacing lead region may prohibit response to CRT. Evaluation for viability and scar tissue may be considered in the selection process for CRT.

Key Words: Cardiac resynchronization therapy • Heart failure • Nuclear imaging • Viability


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