FOCUS ISSUE: CARDIAC IMAGING: DELAYED ENHANCEMENT MAGNETIC RESONANCE
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
Manuscript received February 23, 2006;
revised manuscript received May 22, 2006,
accepted July 10, 2006.
* Reprint requests and correspondence: Dr. Raymond Yee, Room C6-114, University Hospital–London Health Sciences Centre, 339 Windermere Road, London, Ontario, Canada N6A 5A5. (Email: ryee{at}uwo.ca).
OBJECTIVES: We evaluated the ability of delayed enhancement magnetic resonance imaging (DE-MRI) to predict clinical response to cardiac resynchronization therapy (CRT).
BACKGROUND: Cardiac resynchronization therapy reduces morbidity and mortality in selected heart failure patients. However, up to 30% of patients do not have a response. We hypothesized that scar burden on DE-MRI predicts response to CRT.
METHODS: The DE-MRI was performed on 28 heart failure patients undergoing CRT. Patients with QRS  120 ms, left ventricular ejection fraction  35%, New York Heart Association functional class II to IV, and dyssynchrony 60 ms were studied. Baseline and 3-month clinical follow-up, wall motion, 6-min walk, and quality of life assessment were performed. The DE-MRI was performed 10 min after 0.20 mmol/kg intravenous gadolinium. Scar measured by planimetry was correlated with response criteria.
RESULTS: Twenty-three patients completed the protocol (mean age 64.9 ± 11.7 years), with 12 (52%) having a history of myocardial infarction. Thirteen (57%) patients met response criteria. Percent total scar was significantly higher in the nonresponse versus response group (median and interquartile range of 24.7% [18.1 to 48.7] vs. 1.0% [0.0 to 8.7], p = 0.0022) and predicted nonresponse by receiver-operating characteristic analysis (area = 0.94). At a cutoff value of 15%, percent total scar provided a sensitivity and specificity of 85% and 90%, respectively, for clinical response to CRT. Similarly, septal scar 40% provided a 100% sensitivity and specificity for response. Regression analysis showed linear correlations between percent total scar and change in each of the individual response criteria.
CONCLUSIONS: The DE-MRI accurately predicted clinical response to CRT. This technique offers unique information in the assessment of patients referred for CRT.
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Abbreviations and Acronyms
| | CRT = cardiac resynchronization therapy | | DE-MRI = delayed-enhancement magnetic resonance imaging | | LV = left ventricle/ventricular | | LVEF = left ventricular ejection fraction | | NYHA = New York Heart Association |
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