Intraventricular Dyssynchrony Predicts Mortality and Morbidity After Cardiac Resynchronization TherapyA Study Using Cardiovascular Magnetic Resonance Tissue Synchronization Imaging
Shajil Chalil, MRCP*,1,
Berthold Stegemann, PhD ,2,
Sarkaw Muhyaldeen, MRCP*,1,
Kayvan Khadjooi, MRCP*,
Russell E.A. Smith, MD, FRCP*,3,
Paul J. Jordan, FRCP*,3 and
Francisco Leyva, MD, FRCP*,3,4,*
* Department of Cardiology, Good Hope Hospital, Sutton Coldfield/Birmingham, West Midlands, England
Medtronic Inc., Bakken Research Center, Maastricht, the Netherlands.
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Figure 1 Myocardial Wall Motion in a Control Subject and in a Patient With Heart Failure
(A) Division of the left ventricular (LV) myocardium into slices and segments. (B) The junction between the interventricular septum and the right ventricular (RV) free wall delimits the beginning of segment 1 and the end of segment 6, counting clockwise. (C and D) Representative graph of radial wall motion of LV segments throughout the cardiac cycle in an LV basal slice in a control subject (C) and in a patient with heart failure (HF) and a left bundle branch block (LBBB) (D).
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Figure 2 CMR-TSI Polar Color Maps in a Healthy Control Subject and in a Patient With Heart Failure and an LBBB
Note the late contraction of the inferoposterior wall in the patient with heart failure and a left bundle branch block (LBBB). CMR-TSI = cardiovascular magnetic resonance tissue synchronization index.
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Figure 3 Intraventricular Dyssynchrony in Control Subjects and in Patients With HF
Box and whisker plot for CMR-TSI in 20 healthy control subjects with a QRS <120 ms and in 66 patients with heart failure, grouped according to QRS <120 ms, QRS 120 to 149 ms, and QRS  150 ms. The 5 horizontal lines represent the 10th, 25th, 50th, 75th, and 90th percentiles, from bottom to top. CMR-TSI = cardiovascular magnetic resonance tissue synchronization index; HF = heart failure.
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Figure 4 Receiver-Operating Characteristic Curves for CMR-TSI in Relation to Clinical End Points
AUC = area under the curve; MCE = major cardiovascular events; sens = sensitivity; spec = specificity; other abbreviations as in Figure 3.
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Figure 5 Kaplan-Meier Estimates of the Time to the Various Clinical End Points
Patients were stratified according to a pre-implant cardiovascular magnetic resonance tissue synchronization imaging score (CMR-TSI) <110 ms or CMR-TSI 110 ms. Results of univariate Cox proportional hazards analyses are expressed in terms of the hazard ratio (HR) and 95% confidence limits. HF = heart failure; MCE = major cardiovascular events.
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