Current and future role of cardiovascular magnetic resonance in cardiac resynchronization therapy

Abstract

Cardiac resynchronization therapy (CRT) has revolutionized the treatment of selected patients with systolic heart failure. It is well recognized, however, that the symptomatic response to and the outcome of CRT is highly variable. The degree of pre-implant mechanical dyssynchrony and the extent as well as the localization of myocardial scarring are known to contribute to this variability. Cardiovascular magnetic resonance (CMR) is the gold-standard imaging modality for the assessment of myocardial structure and function. Recently, CMR has also been shown to be useful in assessing cardiac dyssynchrony and in guiding left ventricular lead deployment away from scarred myocardium. This review explores the current role of CMR in risk stratification and in guiding LV lead deployment. The potential of CMR in identifying the arrhythmogenic substrate is also discussed.

Metabolomic does not predict response to cardiac resynchronization therapy in patients with heart failure

“…29 An increase in LVEF above 7.5% during low-dose dobutamine echocardiography exhibited a sensitivity of 76% and a specificity of 86% in predicting response to CRT. 30 The burden and the transmural extension of myocardial scar measured by cardiovascular MRI have been shown to be associated with a poor response rate to CRT, 31 similar to a high scar burden quantified by single photon emission computed tomography myocardial perfusion imaging. 32 Other clinical, electromechanical and electrophysiological issues before device implantation have been identified by Mullens et al 29 In the present study, we demonstrated that metabolomic is unable to predict the outcome of CRT patients: NOESY, CPMG and DIFF spectra for both serum and urine samples showed very low discrimination accuracy (from 43.7 to 50.8%) that precludes its use in common clinical practice.…”

Assessment of left ventricular mechanical dyssynchrony in left bundle branch block canine model: Comparison between cine and tagged MRI

“…In a canine model of LBBB, the proposed method shows good correlation with tagged MRI, which can be considered the reference standard for myocardial motion analysis. The use of MRI in the context of CRT delivery presents advantages over echocardiography, especially for ischemic heart disease, as late gadolinium enhancement imaging allows avoiding LV lead deployment in the scarred myocardium.…”

2014 Korean Guidelines for Appropriate Utilization of Cardiovascular Magnetic Resonance Imaging: A Joint Report of the Korean Society of Cardiology and the Korean Society of Radiology

“…Despite no CMR criteria suggested by the heart failure guideline published in 2012, 104) CMR-based ICD therapy seems to hold promise in the prediction of patients who may benefit from ICD therapy. The same strategy can be true for determining potential candidates of cardiac resynchronization therapy (CRT) or for planning CRT procedures, [135][136][137] but this has yet to be confirmed with more data.…”