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

176 Scopus citations

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
Publication statusPublished - Sep 1 2008
Externally publishedYes

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Keywords

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

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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