Prediction of response to cardiac resynchronization therapy using left ventricular pacing lead position and cardiovascular magnetic resonance derived wall motion patterns: a prospective cohort study

• Type of Material: Article
• Authors: Gregory R. Hartlage, Emory University; Jonathan D. Suever, Georgia Institute of Technology; Stephanie Clement-Guinaudeau, Emory University; Patrick T. Strickland, Emory University; Nima Ghasemzadeh, Emory University; R. Patrick Magrath, Georgia Institute of Technology; Ankit Parikh, Emory University; Stamatios Lerakis, Emory University; Michael Hoskins, Emory University; Angel Leon, Emory University; Michael Lloyd, Emory University; John Oshinski, Emory University
• Language: English
• Date: 2015-07-14
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © Hartlage et al. 2015
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12968-015-0158-5
• Title of Journal or Parent Work: Journal of Cardiovascular Magnetic Resonance
• Volume: 17
• Issue: 1
• Start Page: 57
• End Page: 57
• Grant/Funding Information: Grant from the National Heart Lung and Blood Institute (award number HL109979, Oshinski; Bethesda, MD),; The National Center for Advancing Translational Sciences of the National Institutes of Health (award number UL1TR000454; Bethesda, MD).; This research was funded by the American Heart Association Grant-in-Aid (award number 13GRNT16950042, Oshinski; Dallas, TX)
• Keywords: Cardiovascular magnetic resonance; Cardiac resynchronization therapy; Dyssynchrony
• Research Categories: Engineering, Biomedical; Health Sciences, Radiology

Abstract

© 2015 Hartlage et al. Background: Despite marked benefits in many heart failure patients, a considerable proportion of patients treated with cardiac resynchronization therapy (CRT) fail to respond appropriately. Recently, a "U-shaped" (type II) wall motion pattern identified by cardiovascular magnetic resonance (CMR) has been associated with improved CRT response compared to a homogenous (type I) wall motion pattern. There is also evidence that a left ventricular (LV) lead localized to the latest contracting LV site predicts superior response, compared to an LV lead localized remotely from the latest contracting LV site. Methods: We prospectively evaluated patients undergoing CRT with pre-procedural CMR to determine the presence of type I and type II wall motion patterns and pre-procedural echocardiography to determine end systolic volume (ESV). We assessed the final LV lead position on post-procedural fluoroscopic images to determine whether the lead was positioned concordant to or remote from the latest contracting LV site. CRT response was defined as ≥15 % reduction in ESV on a 6 month follow-up echocardiogram. Results: The study included 33 patients meeting conventional indications for CRT with a mean New York Heart Association class of 2.8 ± 0.4 and mean LV ejection fraction of 28 ± 9 %. Overall, 55 % of patients were echocardiographic responders by ESV criteria. Patients with both a type II pattern and an LV lead concordant to the latest contracting site (T2CL) had a response rate of 92 %, compared to a response rate of 33 % for those without T2CL (p = 0.003). T2CL was the only independent predictor of response on multivariate analysis (odds ratio 18, 95 % confidence interval 1.6-206; p = 0.018). T2CL resulted in significant incremental improvement in prediction of echocardiographic response (increase in the area under the receiver operator curve from 0.69 to 0.84; p = 0.038). Conclusions: The presence of a type II wall motion pattern on CMR and a concordant LV lead predicts superior CRT response. Improving patient selection by evaluating wall motion pattern and targeting LV lead placement may ultimately improve the response rate to CRT.