Cardiac resynchronization therapy guided by multimodality cardiac imaging.

Autor: Bertini M; Department of Cardiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy. doc.matber@gmail.com., Mele D; Department of Cardiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy., Malagù M; Department of Cardiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy., Fiorencis A; Department of Cardiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy., Toselli T; Department of Cardiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy., Casadei F; Department of Cardiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy., Cannizzaro T; Department of Radiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy., Fragale C; Department of Cardiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy., Fucili A; Department of Cardiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy., Campagnolo E; Department of Cardiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy., Benea G; Department of Radiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy., Ferrari R; Department of Cardiology and LTTA Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy.
Jazyk: angličtina
Zdroj: European journal of heart failure [Eur J Heart Fail] 2016 Nov; Vol. 18 (11), pp. 1375-1382. Date of Electronic Publication: 2016 Jul 13.
DOI: 10.1002/ejhf.605
Abstrakt: Aims: Up to 30-45% of implanted patients are non-responders to CRT. We evaluated the role of a 'CRT team' using cardiac magnetic resonance (CMR) and longitudinal myocardial strain to identify the target area defined as the most delayed and viable region for LV pacing.
Methods and Results: A total of 100 heart failure patients candidates for CRT divided into two groups were enrolled. Group 1 consisted of 50 consecutive patients scheduled for CRT and prospectively included. Group 2 (control) consisted of 50 patients with a CRT device implanted according to standard clinical practice and matched for age, sex, and LVEF with group 1. Patients were evaluated at baseline and at 6-month follow-up. In group 1, patients underwent two-dimensional speckle-tracking assessment of longitudinal myocardial strain and CMR imaging to identify the target area for LV lead pacing. A positive response to CRT was defined as a reduction of ≥15% of the LV end-systolic volume at 6-month follow-up. A total of 39 (78%) patients of group 1 were classified as responders to CRT whilst in group 2, only 28 (56%) were responders (P = 0.019). The 'CRT team' identified as target for LV pacing the lateral area in 30 (60%) patients, and the anterolateral or posterolateral areas in 12 (24%) patients. In 8 (16%) patients, the target was far from the lateral area, in the anterior or posterior areas. The patients with concordant position exhibited the highest positive response (93.1%) to CRT.
Conclusions: Multimodality cardiac imaging as a guide for CRT implantation is useful to increase response rate.
(© 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.)
Databáze: MEDLINE
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