CLINICAL RESEARCH: CARDIAC RESYNCHRONIZATION THERAPY
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.
Manuscript received November 20, 2006;
revised manuscript received March 9, 2007,
accepted March 13, 2007.
* Reprint requests and correspondence: Dr. Francisco Leyva, Department of Cardiology, Good Hope Hospital, Rectory Road, Sutton Coldfield/Birmingham, West Midlands B75 7RR, United Kingdom. (Email: francisco.leyva{at}heartofengland.nhs.uk).
Objectives: We aimed to assess a novel measure of left ventricular (LV) dyssynchrony, a cardiovascular magnetic resonance-tissue synchronization index (CMR-TSI), in patients with heart failure (HF). A further aim was to determine whether CMR-TSI predicts mortality and major cardiovascular events (MCE) after cardiac resynchronization therapy (CRT).
Background: Cardiac dyssynchrony is a predictor of mortality in patients with HF. The unparalleled spatial resolution of CMR may render CMR-TSI a predictor of clinical benefit after CRT.
Methods: In substudy A, CMR-TSI was assessed in 66 patients with HF (age 60.8 ± 10.8 years, LV ejection fraction 23.9 ± 12.1% [mean ± SD]) and 20 age-matched control subjects. In substudy B, CMR-TSI was assessed in relation to clinical events in 77 patients with HF and with a QRS  120 ms undergoing CRT.
Results: In analysis A, CMR-TSI was higher in patients with HF and a QRS <120 ms (79.5 ± 31.2 ms, p = 0.0003) and in those with a QRS 120 ms (105.9 ± 55.8 ms, p < 0.0001) than in control subjects (21.2 ± 8.1 ms). In analysis B, a CMR-TSI 110 ms emerged as an independent predictor of the composite end points of death or unplanned hospitalization for MCE (hazard ratio [HR] 2.45; 95% confidence interval [CI] 1.51 to 4.34, p = 0.0002) or death from any cause or unplanned hospitalization for HF (HR 2.15; 95% CI 1.23 to 4.14, p = 0.0060) as well as death from any cause (HR: 2.6; 95% CI 1.29 to 6.73, p = 0.0061) and cardiovascular death (HR 3.82; 95% CI 1.63 to 16.5, p = 0.0007) over a mean follow-up of 764 days.
Conclusions: Myocardial dyssynchrony assessed by CMR-TSI is a powerful independent predictor of mortality and morbidity after CRT.
|
Abbreviations and Acronyms
| | CMR-TSI = cardiovascular magnetic resonance-tissue synchronization index | | CRT = cardiac resynchronization therapy | | HF = heart failure | | LV = left ventricle/ventricular | | LVEDV = left ventricular end-diastolic volume | | LVEF = left ventricular ejection fraction | | LVESV = left ventricular end-systolic volume | | MCE = major cardiovascular events | | NYHA = New York Heart Association | | ROC = receiver-operating characteristic |
|
Related Article
-
Inside This Issue of JACC
J. Am. Coll. Cardiol. 2007 50: A27-A28.
[Full Text]
[PDF]
This article has been cited by other articles:
|
|
|
|
 
P. W. X. Foley, K. Patel, N. Irwin, J. E. Sanderson, M. P. Frenneaux, R. E. A. Smith, B. Stegemann, and F. Leyva
Cardiac resynchronisation therapy in patients with heart failure and a normal QRS duration: the RESPOND study
Heart,
July 1, 2011;
97(13):
1041 - 1047.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. W.-K. Yip and J. W. H. Fung
Cardiac resynchronisation therapy for heart failure with narrow or normal QRS
Heart,
July 1, 2011;
97(13):
1029 - 1031.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Delgado and J. J. Bax
Assessment of Systolic Dyssynchrony for Cardiac Resynchronization Therapy Is Clinically Useful
Circulation,
February 15, 2011;
123(6):
640 - 655.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Gorcsan III, O. Oyenuga, P. J. Habib, H. Tanaka, E. C. Adelstein, H. Hara, D. M. McNamara, and S. Saba
Relationship of Echocardiographic Dyssynchrony to Long-Term Survival After Cardiac Resynchronization Therapy
Circulation,
November 9, 2010;
122(19):
1910 - 1918.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. E. Thomas, S. A. Exton, and Z. R. Yousef
Heart rate deceleration after exercise predicts patients most likely to respond to cardiac resynchronisation therapy
Heart,
September 1, 2010;
96(17):
1385 - 1389.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. H. Marwick and R. A. Grimm
Extending the Use of Cardiac Resynchronization Therapy: Do We Need a New Algorithm?
J. Am. Coll. Cardiol.,
August 31, 2010;
56(10):
763 - 765.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. J. Taylor, M. Elsik, A. Broughton, J. Cherayath, A. Leet, C. Wong, L. Iles, M. Butler, and H. Pfluger
Combined dyssynchrony and scar imaging with cardiac magnetic resonance imaging predicts clinical response and long-term prognosis following cardiac resynchronization therapy
Europace,
May 1, 2010;
12(5):
708 - 713.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. J. Pennell
Cardiovascular Magnetic Resonance
Circulation,
February 9, 2010;
121(5):
692 - 705.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. D. Karamitsos, J. M. Francis, S. Myerson, J. B. Selvanayagam, and S. Neubauer
The Role of Cardiovascular Magnetic Resonance Imaging in Heart Failure
J. Am. Coll. Cardiol.,
October 6, 2009;
54(15):
1407 - 1424.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. A. Marsan, J. J.M. Westenberg, C. Ypenburg, R. J. van Bommel, S. Roes, V. Delgado, L. F. Tops, R. J. van der Geest, E. Boersma, A. de Roos, et al.
Magnetic resonance imaging and response to cardiac resynchronization therapy: relative merits of left ventricular dyssynchrony and scar tissue
Eur. Heart J.,
October 1, 2009;
30(19):
2360 - 2367.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F Leyva, P W X Foley, B Stegemann, J A Ward, L L Ng, M P Frenneaux, F Regoli, R E A Smith, and A Auricchio
Development and validation of a clinical index to predict survival after cardiac resynchronisation therapy
Heart,
October 1, 2009;
95(19):
1619 - 1625.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Bax and J. Gorcsan III
Echocardiography and Noninvasive Imaging in Cardiac Resynchronization Therapy: Results of the PROSPECT (Predictors of Response to Cardiac Resynchronization Therapy) Study in Perspective
J. Am. Coll. Cardiol.,
May 26, 2009;
53(21):
1933 - 1943.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. S. Flett, M. A. Westwood, L. C. Davies, A. Mathur, and J. C. Moon
The Prognostic Implications of Cardiovascular Magnetic Resonance
Circ Cardiovasc Imaging,
May 1, 2009;
2(3):
243 - 250.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Q. A. Truong, J. P. Singh, C. P. Cannon, A. Sarwar, K. Nasir, A. Auricchio, F. F. Faletra, A. Sorgente, C. Conca, T. Moccetti, et al.
Quantitative Analysis of Intraventricular Dyssynchrony Using Wall Thickness by Multidetector Computed Tomography.
J. Am. Coll. Cardiol. Img.,
November 1, 2008;
1(6):
772 - 781.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Saeed, A. Martin, P. Ursell, L. Do, M. Bucknor, C. B. Higgins, and D. Saloner
MR Assessment of Myocardial Perfusion, Viability, and Function after Intramyocardial Transfer of VM202, a New Plasmid Human Hepatocyte Growth Factor in Ischemic Swine Myocardium
Radiology,
October 1, 2008;
249(1):
107 - 118.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. C. Bilchick, V. Dimaano, K. C. Wu, R. H. Helm, R. G. Weiss, J. A. Lima, R. D. Berger, G. F. Tomaselli, D. A. Bluemke, H. R. Halperin, et al.
Cardiac magnetic resonance assessment of dyssynchrony and myocardial scar predicts function class improvement following cardiac resynchronization therapy.
J. Am. Coll. Cardiol. Img.,
September 1, 2008;
1(5):
561 - 568.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. W. Prinzen and A. Auricchio
Is echocardiographic assessment of dyssynchrony useful to select candidates for cardiac resynchronization therapy?: Echocardiography Is Not Useful Before Cardiac Resynchronization Therapy if QRS Duration Is Available
Circ Cardiovasc Imaging,
July 1, 2008;
1(1):
70 - 78.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. A. Kass
An Epidemic of Dyssynchrony: But What Does It Mean?
J. Am. Coll. Cardiol.,
January 1, 2008;
51(1):
12 - 17.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. F. Nagueh
Mechanical Dyssynchrony in Congestive Heart Failure: Diagnostic and Therapeutic Implications
J. Am. Coll. Cardiol.,
January 1, 2008;
51(1):
18 - 22.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
