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

Kenneth C. Bilchick, Veronica Dimaano, Katherine C. Wu, Robert H. Helm, Robert G. Weiss, Joao A. Lima, Ronald D. Berger, Gordon F. Tomaselli, David A. Bluemke, Henry R. Halperin, Theodore Abraham, David A. Kass, Albert C. Lardo

Research output: Contribution to journalArticle

174 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)561-568
Number of pages8
JournalJACC: Cardiovascular Imaging
Volume1
Issue number5
DOIs
StatePublished - Sep 1 2008
Externally publishedYes

Fingerprint

Cardiac Resynchronization Therapy
Cicatrix
Magnetic Resonance Spectroscopy
Heart Failure
Cardiomyopathies
Stroke Volume
Area Under Curve
Healthy Volunteers

Keywords

  • biventricular
  • cardiac magnetic resonance
  • cardiac resynchronization therapy
  • dyssynchrony
  • heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Cardiac Magnetic Resonance Assessment of Dyssynchrony and Myocardial Scar Predicts Function Class Improvement Following Cardiac Resynchronization Therapy. / Bilchick, Kenneth C.; Dimaano, Veronica; Wu, Katherine C.; Helm, Robert H.; Weiss, Robert G.; Lima, Joao A.; Berger, Ronald D.; Tomaselli, Gordon F.; Bluemke, David A.; Halperin, Henry R.; Abraham, Theodore; Kass, David A.; Lardo, Albert C.

In: JACC: Cardiovascular Imaging, Vol. 1, No. 5, 01.09.2008, p. 561-568.

Research output: Contribution to journalArticle

Bilchick, KC, Dimaano, V, Wu, KC, Helm, RH, Weiss, RG, Lima, JA, Berger, RD, Tomaselli, GF, Bluemke, DA, Halperin, HR, Abraham, T, Kass, DA & Lardo, AC 2008, 'Cardiac Magnetic Resonance Assessment of Dyssynchrony and Myocardial Scar Predicts Function Class Improvement Following Cardiac Resynchronization Therapy', JACC: Cardiovascular Imaging, vol. 1, no. 5, pp. 561-568. https://doi.org/10.1016/j.jcmg.2008.04.013
Bilchick, Kenneth C. ; Dimaano, Veronica ; Wu, Katherine C. ; Helm, Robert H. ; Weiss, Robert G. ; Lima, Joao A. ; Berger, Ronald D. ; Tomaselli, Gordon F. ; Bluemke, David A. ; Halperin, Henry R. ; Abraham, Theodore ; Kass, David A. ; Lardo, Albert C. / Cardiac Magnetic Resonance Assessment of Dyssynchrony and Myocardial Scar Predicts Function Class Improvement Following Cardiac Resynchronization Therapy. In: JACC: Cardiovascular Imaging. 2008 ; Vol. 1, No. 5. pp. 561-568.
@article{a6b82daa8d2643d28e8c4ed4c21e9391,
title = "Cardiac Magnetic Resonance Assessment of Dyssynchrony and Myocardial Scar Predicts Function Class Improvement Following Cardiac Resynchronization Therapy",
abstract = "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.",
keywords = "biventricular, cardiac magnetic resonance, cardiac resynchronization therapy, dyssynchrony, heart failure",
author = "Bilchick, {Kenneth C.} and Veronica Dimaano and Wu, {Katherine C.} and Helm, {Robert H.} and Weiss, {Robert G.} and Lima, {Joao A.} and Berger, {Ronald D.} and Tomaselli, {Gordon F.} and Bluemke, {David A.} and Halperin, {Henry R.} and Theodore Abraham and Kass, {David A.} and Lardo, {Albert C.}",
year = "2008",
month = "9",
day = "1",
doi = "10.1016/j.jcmg.2008.04.013",
language = "English (US)",
volume = "1",
pages = "561--568",
journal = "JACC: Cardiovascular Imaging",
issn = "1936-878X",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Cardiac Magnetic Resonance Assessment of Dyssynchrony and Myocardial Scar Predicts Function Class Improvement Following Cardiac Resynchronization Therapy

AU - Bilchick, Kenneth C.

AU - Dimaano, Veronica

AU - Wu, Katherine C.

AU - Helm, Robert H.

AU - Weiss, Robert G.

AU - Lima, Joao A.

AU - Berger, Ronald D.

AU - Tomaselli, Gordon F.

AU - Bluemke, David A.

AU - Halperin, Henry R.

AU - Abraham, Theodore

AU - Kass, David A.

AU - Lardo, Albert C.

PY - 2008/9/1

Y1 - 2008/9/1

N2 - 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.

AB - 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.

KW - biventricular

KW - cardiac magnetic resonance

KW - cardiac resynchronization therapy

KW - dyssynchrony

KW - heart failure

UR - http://www.scopus.com/inward/record.url?scp=51549083817&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=51549083817&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2008.04.013

DO - 10.1016/j.jcmg.2008.04.013

M3 - Article

C2 - 19356481

AN - SCOPUS:51549083817

VL - 1

SP - 561

EP - 568

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

SN - 1936-878X

IS - 5

ER -