Europace Advance Access originally published online on October 12, 2007
Europace 2007 9(11):1031-1037; doi:10.1093/europace/eum133
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CARDIAC RESYNCHRONISATION THERAPY
Late gadolinium enhancement-cardiovascular magnetic resonance as a predictor of response to cardiac resynchronization therapy in patients with ischaemic cardiomyopathy
1 Department of Cardiology, University of Birmingham, Good Hope Hospital, Rectory Road, Sutton Coldfield, West Midlands B75 7RR, UK; 2 City and Sandwell Hospitals, Birmingham, UK; 3 Department of Cardiology, University of Birmingham, Queen Elizabeth Hospital, Birmingham, UK
Aim: To determine whether myocardial scarring, quantified using late gadolinium enhancement-cardiovascular magnetic resonance (LGE-CMR), predicts response to cardiac resynchronization therapy (CRT).
Methods and results: A total of 45 patients with ischaemic cardiomyopathy [age 67.1 ± 10.4 years (mean ± SD)] underwent assessment of 6 min walking distance (6MWD) and quality of life (QoL) before and after CRT. Scar size (percentage of left ventricular mass), location, and transmurality were assessed prior to CRT using LGE-CMR. Responders (survived for 1year with no heart failure hospitalizations, and improvement by 
1 NYHA classes or 25% 6MWD) had a higher left ventricular ejection fraction (P = 0.048), smaller scars (<33%) (P = 0.009), and fewer scars with 51% transmurality (P = 0.002). Scar size correlated negatively with change in 6MWD (r = –0.54, P < 0.001) and positively with changes in QoL scores (r = 0.35, P = 0.028). Responder rates in patients with <33% scar were higher than in those with 33% scar (82 vs. 35%, P < 0.01). Responder rates in patients with scar transmurality <51% were higher than in those with 51% (89 vs. 46%, P < 0.01). Among the patients with posterolateral scars, a transmurality value of 51% was associated with a particularly poor response rate (23%), compared with scars with <51% transmurality (88%, P < 0.001). In multivariate analyses, both scar size (P = 0.022) and transmurality (P = 0.004) emerged as predictors of response. In patients with posterolateral scars, pacing outside the scar was associated with a better responder rate than pacing over the scar (86 vs. 33%, P = 0.004).
Conclusions: In patients with ischaemic cardiomyopathy, a scar size 33%, a transmurality 51%, and pacing over a posterolateral scar are associated with a suboptimal response to CRT.
Key Words: Cardiac resynchronization therapy, Heart failure, Cardiovascular magnetic resonance, Myocardial viability
* Corresponding author. Tel: +44 121 3786604; fax: +44 121 3786188. E-mail address: francisco.leyva{at}goodhope.nhs.uk
Manuscript submitted 25 November 2006. Accepted after revision 8 June 2007.
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