PMID- 22056486
OWN - NLM
STAT- MEDLINE
DCOM- 20130124
LR  - 20151119
IS  - 1872-7727 (Electronic)
IS  - 0720-048X (Linking)
VI  - 81
IP  - 10
DP  - 2012 Oct
TI  - Magnetic resonance imaging assessment of intraventricular dyssynchrony and 
      delayed enhancement as predictors of response to cardiac resynchronization 
      therapy in patients with heart failure of ischaemic and non-ischaemic etiologies.
PG  - 2639-47
LID - 10.1016/j.ejrad.2011.10.003 [doi]
AB  - PURPOSE: To assess the value of dyssynchrony and myocardial viability assessment 
      by cardiac magnetic resonance (CMR) in prediction of response to cardiac 
      resynchronization therapy (CRT) in patients with heart failure (HF) of both 
      ischaemic and non-ischaemic etiologies. MATERIALS AND METHODS: Patients scheduled 
      for CRT in NYHA class II-IV, left ventricular ejection fraction <35%, QRS >/= 120 
      ms were included. Tagged cine and late gadolinium enhancement (LGE) images were 
      performed. Dyssynchrony was assessed with inTag toolbox and LGE was quantified 
      using cutoff value at half of maximal signal in the scar. Cardiopulmonary 
      exercise test, echocardiography and blood testing for NT-proBNP levels were done 
      at baseline and 6 months after CRT. RESULTS: 52 patients (age 60.3 +/- 13 years) 
      were included. 26 patients (50%) met response criteria. The ischaemic etiology of 
      HF was more frequent (69% vs. 31%, p=0.002), the percent of LGE was higher (7.7% 
      [0-13.5%] vs. 19.0% (0-31.9%], p=0.013), regional vector of circumferential 
      strain variance (RVV) was lower (0.27 +/- 0.08 vs. 0.34 +/- 0.09, p=0.009) and 
      uniformity of radial strain was higher (0.72 +/- 0.25 vs. 0.56 +/- 0.29, p=0.046) in 
      non-responders vs. responders. Multivariate logistic regression showed that RVV 
      predicted response to CRT (HR 2.3, 95% CI 1.02-5.02, p=0.0430) independently of 
      LGE and the etiology of heart failure. In the subgroup of patients with ischaemic 
      HF the extend of transmural scar within myocardium was higher in non-responders 
      vs. responders (26.3% vs. 15.0% respectively, p=0.01) and was a predictor of 
      response to CRT in univariable analysis (HR 0.87, 95% CI 0.77-0.98, p=0.025) 
      providing the sensitivity of 76% and specificity of 75% at the cutoff point of 
      18% in the prediction of poor response to CRT. In patients with non-ischaemic HF 
      QRS was wider (162 ms vs. 140 ms, p=0.04), regional vector of strain variance 
      (RVV) was higher (0.39 vs. 0.25, p=0.002) and uniformity of radial strain was 
      lower (0.52 vs. 0.80, p=0.049) in non-responders vs. responders. Univariable 
      logistic regression showed that RVV was a predictor of response to CRT (HR 1.50, 
      95% CI 1.06-2.13, p=0.022), providing the sensitivity of 94% and specificity of 
      85% at the cutoff point of 0.31. CONCLUSIONS: CMR derived parameters of 
      dyssynchrony such as RVV may provide an additive value in prediction of response 
      to CRT, especially in patients with non-ischaemic etiology of heart failure. In 
      patients with ischaemic HF the transmurality of LGE is an important predictor of 
      lack of response to CRT.
CI  - Copyright (c) 2011 Elsevier Ireland Ltd. All rights reserved.
FAU - Petryka, Joanna
AU  - Petryka J
AD  - Department of Coronary Artery Disease and Structural Heart Diseases, Institute of 
      Cardiology, Warsaw, Poland. joannapetryka@hotmail.com
FAU - Misko, Jolanta
AU  - Misko J
FAU - Przybylski, Andrzej
AU  - Przybylski A
FAU - Spiewak, Mateusz
AU  - Spiewak M
FAU - Malek, Lukasz A
AU  - Malek LA
FAU - Werys, Konrad
AU  - Werys K
FAU - Mazurkiewicz, Lukasz
AU  - Mazurkiewicz L
FAU - Gepner, Katarzyna
AU  - Gepner K
FAU - Croisille, Pierre
AU  - Croisille P
FAU - Demkow, Marcin
AU  - Demkow M
FAU - Ruzyllo, Witold
AU  - Ruzyllo W
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20111106
PL  - Ireland
TA  - Eur J Radiol
JT  - European journal of radiology
JID - 8106411
RN  - 0 (Contrast Media)
RN  - AU0V1LM3JT (Gadolinium)
SB  - IM
MH  - Cardiac Resynchronization Therapy
MH  - Contrast Media/administration & dosage
MH  - Female
MH  - Gadolinium/administration & dosage
MH  - Heart Failure/*diagnosis/etiology/*prevention & control
MH  - Humans
MH  - Image Enhancement/methods
MH  - Magnetic Resonance Imaging, Cine/*methods
MH  - Male
MH  - Middle Aged
MH  - Myocardial Ischemia/complications/*diagnosis/*prevention & control
MH  - Prognosis
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/*diagnosis/etiology/*prevention & control
EDAT- 2011/11/08 06:00
MHDA- 2013/01/25 06:00
CRDT- 2011/11/08 06:00
PHST- 2011/06/30 00:00 [received]
PHST- 2011/10/03 00:00 [revised]
PHST- 2011/10/08 00:00 [accepted]
PHST- 2011/11/08 06:00 [entrez]
PHST- 2011/11/08 06:00 [pubmed]
PHST- 2013/01/25 06:00 [medline]
AID - S0720-048X(11)00727-3 [pii]
AID - 10.1016/j.ejrad.2011.10.003 [doi]
PST - ppublish
SO  - Eur J Radiol. 2012 Oct;81(10):2639-47. doi: 10.1016/j.ejrad.2011.10.003. Epub 
      2011 Nov 6.