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Delayed Enhancement Magnetic Resonance Imaging Predicts Response to Cardiac Resynchronization Therapy in Patients With Intraventricular Dyssynchrony

James A. White, MD^_*, Raymond Yee, MD^_*,_*, Xiaping Yuan, PhD, Andrew Krahn, MD^_*, Allan Skanes, MD^_*, Michele Parker, MS, George Klein, MD^_* and Maria Drangova, PhD^,

^_* Division of Cardiology, Department of Medicine, University of Western Ontario, London, Ontario, Canada
Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
Duke Cardiac Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada

View larger version (67K): [in this window] [in a new window] [Download PPT slide]   Figure 1 Short-axis delayed-enhancement magnetic resonance image showing a large area of scarred (bright) myocardium in the septal, anteroseptal, and anterior walls. Area planimetry of total wall and total scar area (yellow line) was performed as illustrated.

View larger version (146K): [in this window] [in a new window] [Download PPT slide]   Figure 2 Examples of scar distribution (bright signal) on delayed-enhancement magnetic resonance imaging from clinical nonresponders (top row), responders without scar (middle row), and responders with scar (bottom row).

View larger version (88K): [in this window] [in a new window] [Download PPT slide]   Figure 3 Typical scar patterns seen on delayed-enhancement magnetic resonance imaging imaging in clinical responders with (A) history of myocardial infarction and (B) no history of myocardial infarction (scar indicated by white arrows).

View larger version (10K): [in this window] [in a new window] [Download PPT slide]   Figure 4 Receiver-operating characteristic analysis of total percent scar for the prediction of clinical response to cardiac resynchronization therapy.

View larger version (19K): [in this window] [in a new window] [Download PPT slide]   Figure 5 Linear regression plots showing the relationship between total percent scar and change in (A) left ventricular ejection fraction (EF), (B) quality-of-life (QOL) score, (C) 6-min walk, and (D) New York Heart Association (NYHA) functional class at follow-up.