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- Title
Cardiac Magnetic Resonance Identifies Responders to Cardiac Resynchronization Therapy with an Assessment of Septal Scar and Left Ventricular Dyssynchrony.
- Authors
Larsen, Camilla Kjellstad; Smiseth, Otto A.; Duchenne, Jürgen; Galli, Elena; Aalen, John Moene; Lederlin, Mathieu; Bogaert, Jan; Kongsgaard, Erik; Linde, Cecilia; Penicka, Martin; Donal, Erwan; Voigt, Jens-Uwe; Hopp, Einar
- Abstract
Background: The response to cardiac resynchronization therapy (CRT) depends on septal viability and correction of abnormal septal motion. This study investigates if cardiac magnetic resonance (CMR) as a single modality can identify CRT responders with combined imaging of pathological septal motion (septal flash) and septal scar. Methods: In a prospective, multicenter, observational study of 136 CRT recipients, septal scar was assessed using late gadolinium enhancement (LGE) (n = 127) and septal flash visually from cine CMR sequences. The primary endpoint was CRT response, defined as ≥15% reduction in LV end-systolic volume with echocardiography after 6 months. The secondary endpoint was heart transplantation or death of any cause assessed after 39 ± 13 months. Results: Septal scar and septal flash were independent predictors of CRT response in multivariable analysis (both p < 0.001), while QRS duration and morphology were not. The combined approach of septal scar and septal flash predicted CRT response with an area under the curve of 0.86 (95% confidence interval (CI): 0.78–0.94) and was a strong predictor of long-term survival without heart transplantation (hazard ratio 0.27, 95% CI: 0.10–0.79). The accuracy of the approach was similar in the subgroup with intermediate (130–150 ms) QRS duration. The combined approach was superior to septal scar and septal flash alone (p < 0.01). Conclusions: The combined assessment of septal scar and septal flash using CMR as a single-image modality identifies CRT responders with high accuracy and predicts long-term survival.
- Subjects
CARDIAC pacing; CARDIAC magnetic resonance imaging; SCARS; HEART transplantation
- Publication
Journal of Clinical Medicine, 2023, Vol 12, Issue 22, p7182
- ISSN
2077-0383
- Publication type
Article
- DOI
10.3390/jcm12227182