Pre- and Intra-Procedural Predictors of Reverse Remodeling After Cardiac Resynchronization Therapy: An MRI Study

Authors

  • HUBERT COCHET M.D.,

    Corresponding author
    1. L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC, CHU/Université de Bordeaux/INSERM U1045, Pessac, France
    • Department of cardiovascular imaging, CHU/Université de Bordeaux, Pessac, France
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  • ARNAUD DENIS M.D.,

    1. Department of cardiac pacing and electrophysiology, CHU/Université de Bordeaux, Pessac, France
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  • SYLVAIN PLOUX M.D.,

    1. L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC, CHU/Université de Bordeaux/INSERM U1045, Pessac, France
    2. Department of cardiac pacing and electrophysiology, CHU/Université de Bordeaux, Pessac, France
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  • JOOST LUMENS Ph.D.,

    1. Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
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  • SANA AMRAOUI M.D.,

    1. Department of cardiac pacing and electrophysiology, CHU/Université de Bordeaux, Pessac, France
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  • NICOLAS DERVAL M.D.,

    1. L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC, CHU/Université de Bordeaux/INSERM U1045, Pessac, France
    2. Department of cardiac pacing and electrophysiology, CHU/Université de Bordeaux, Pessac, France
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  • FREDERIC SACHER M.D.,

    1. L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC, CHU/Université de Bordeaux/INSERM U1045, Pessac, France
    2. Department of cardiac pacing and electrophysiology, CHU/Université de Bordeaux, Pessac, France
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  • PATRICIA REANT M.D.,

    1. L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC, CHU/Université de Bordeaux/INSERM U1045, Pessac, France
    2. Department of echocardiography, CHU/Université de Bordeaux, Pessac, France
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  • STÉPHANE LAFITTE M.D.,

    1. L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC, CHU/Université de Bordeaux/INSERM U1045, Pessac, France
    2. Department of echocardiography, CHU/Université de Bordeaux, Pessac, France
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  • PIERRE JAIS M.D.,

    1. L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC, CHU/Université de Bordeaux/INSERM U1045, Pessac, France
    2. Department of cardiac pacing and electrophysiology, CHU/Université de Bordeaux, Pessac, France
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  • FRANÇOIS LAURENT M.D.,

    1. Department of cardiovascular imaging, CHU/Université de Bordeaux, Pessac, France
    2. L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC, CHU/Université de Bordeaux/INSERM U1045, Pessac, France
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  • PHILIPPE RITTER M.D.,

    1. L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC, CHU/Université de Bordeaux/INSERM U1045, Pessac, France
    2. Department of cardiac pacing and electrophysiology, CHU/Université de Bordeaux, Pessac, France
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  • MICHEL MONTAUDON M.D.,

    1. Department of cardiovascular imaging, CHU/Université de Bordeaux, Pessac, France
    2. L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC, CHU/Université de Bordeaux/INSERM U1045, Pessac, France
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  • PIERRE BORDACHAR M.D.

    1. L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC, CHU/Université de Bordeaux/INSERM U1045, Pessac, France
    2. Department of cardiac pacing and electrophysiology, CHU/Université de Bordeaux, Pessac, France
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  • No disclosures.

Address for correspondence: Dr. Hubert Cochet, M.D. Departement d'imagerie cardiovasculaire, Hopital cardiologique Haut Lévêque CHU Bordeaux, 33604 Pessac, France. Fax: +33557656880: E-mail: hcochet@wanadoo.fr

MRI Predictors of Reverse Remodeling After CRT

Introduction

Response rate after cardiac resynchronization therapy (CRT) remains suboptimal. We sought to identify pre- and intraprocedural predictors of response using MRI.

Methods and Results

Sixty patients underwent MRI before CRT. Left ventricular (LV) volumes and ejection fraction were assessed on cine images. Intra-LV dyssynchrony was defined as the maximal delay between first peaks of radial wall motion over 20 segments. Myocardial scar extent was quantified using delayed-enhanced MRI. After CRT, the paced LV segment was characterized on preprocedural MRI with respect to presence of scar and mechanical delay, the latter being quantified using time to first peak of wall motion, expressed in percentage of the total LV activation. Echocardiography was performed before and 6 months after CRT to quantify reverse remodeling (RR). Mean RR at 6 months was 30 ± 29% of baseline LV end-systolic volume. At univariate analysis, RR related to baseline LV end-diastolic and end-systolic volumes (R2 = 0.101, P = 0.01; R2 = 0.072, P = 0.04), intra-LV mechanical dyssynchrony (R2 = 0.351, P < 0.0001), scar extent (R2 = 0.273, P < 0.0001), and presence of scar at pacing site (R2 = 0.100, P = 0.01). QRS duration and mechanical delay at pacing site were not found related to RR (R2 = 0.041, P = 0.12 and R2 = 0.012, P = 0.4, respectively). At multivariate analysis intra-LV mechanical dyssynchrony, scar extent, and LV end-diastolic volume were independent predictors of RR (R2 = 0.307, P = 0.001; R2 = 0.096, P = 0.002, R2 = 0.078, P = 0.005, respectively).

Conclusion

Intra-LV dyssynchrony and scar extent are independent predictors of RR after CRT. Scar at pacing site is associated to a lesser response to CRT. Mechanical delay at this site has no impact on the response.

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