Skip Navigation



Europace Advance Access published online on October 12, 2007
Europace, doi:10.1093/europace/eum133
This Article
Right arrow Full Text Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
9/11/1031    most recent
eum133v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Chalil, S.
Right arrow Articles by Leyva, F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Chalil, S.
Right arrow Articles by Leyva, F.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

Late gadolinium enhancement-cardiovascular magnetic resonance as a predictor of response to cardiac resynchronization therapy in patients with ischaemic cardiomyopathy

Shajil Chalil1, Paul W.X. Foley1, Sarkaw A. Muyhaldeen1, Kiran C.R. Patel2, Zaheer R. Yousef1, Russell E.A. Smith1, Michael P. Frenneaux3 and Francisco Leyva1,3,*

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.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 EuropaceHome page
P. W.X. Foley, F. Leyva, and M. P. Frenneaux
What is treatment success in cardiac resynchronization therapy?
Europace, November 1, 2009; 11(suppl_5): v58 - v65.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
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]

Home page
 HeartHome page
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]

Home page
 Eur J EchocardiogrHome page
P. Lancellotti, M. Senechal, M. Moonen, E. Donal, J. Magne, E. Nellessen, E. Attena, B. Cosyns, P. Melon, and L. Pierard
Myocardial contractile reserve during exercise predicts left ventricular reverse remodelling after cardiac resynchronization therapy
Eur J Echocardiogr, July 1, 2009; 10(5): 663 - 668.
[Abstract] [Full Text] [PDF]

Home page
 EuropaceHome page
F. Z. Khan, M. S. Virdee, S. P. Fynn, and D. P. Dutka
Left ventricular lead placement in cardiac resynchronization therapy: where and how?
Europace, May 1, 2009; 11(5): 554 - 561.
[Abstract] [Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.