Left ventricular scar impact on left ventricular synchronization parameters and outcomes of cardiac resynchronization therapy. (1st November 2016)

• Record Type: Journal Article
• Authors: Ahmed, Walid; Samy, Wael; Tayeh, Osama; Behairy, Noha; Abd El Fattah, Alia
• Is Part Of: International journal of cardiology. Volume 222(2016)
• Page Start: 665
• Page End: 670
• Publication Date: 2016-11-01
• Subjects: CMR cardiac magnetic resonance -- CRT cardiac resynchronization therapy -- LV left ventricle -- HF heart failure -- H. histogram -- BW bandwidth -- SD standard deviation -- SRS summed rest score -- DCM dilated cardiomyopathy -- ICM ischemic cardiomyopathy -- ICC intraclass correlation -- No. number -- LVES left ventricular end-systolic volume -- ACCF/AHA American College of Cardiology/American Heart Association; Cardiac resynchronization therapy -- Phase analysis Gated SPECT -- Left ventricular dyssynchrony -- Cardiac magnetic resonance -- Left ventricular scar -- Lateral wall pacing; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.07.158
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Left ventricular scar, including global scar and lateral wall, plays an important role in predicting response to cardiac resynchronization therapy (CRT). Materials and methods: Thirty patients underwent CRT implantation. Assessment of left ventricular (LV) dyssynchrony was done through Gated SPECT LV phase analysis. Pre-implantation cardiac magnetic resonance (CMR) with late gadolinium enhancement technique to examine LV scar burden. Echocardiographic examination of LV end-systolic volume (LVES) prior to CRT and 6 months later. Results: Thirty patients received CRT (mean age 58.7±9.0, 24 males). Reverse LV remodeling (decline ≥ 15% from baseline VES) was documented in 19 patients. Temporal changes in LV dyssynchrony parameters were correlated to LV reverse remodeling. Applying ROC for predicting CRT non-response showed a cutoff 36.5% of global LV scar burden had a sensitivity of 81.8% and specificity of 68.4%. A cutoff for lateral wall scar burden 40.5% of whole lateral wall had a sensitivity of 72.7% and specificity of 68.4%. Conclusion: Reverse LV remodeling is associated with temporal improvements in LV dyssynchrony parameters. LV scar had an unfavorable impact on CRT response. Both global and lateral wall scar burden could predict CRT nonresponse status.