Focal but not diffuse myocardial fibrosis burden quantification using cardiac magnetic resonance imaging predicts left ventricular reverse modeling following cardiac resynchronization therapy

TY - JOUR

T1 - Focal but not diffuse myocardial fibrosis burden quantification using cardiac magnetic resonance imaging predicts left ventricular reverse modeling following cardiac resynchronization therapy

AU - Chen, Zhong

AU - Sohal, Manav

AU - Sammut, Eva

AU - Child, Nick

AU - Jackson, Tom

AU - Claridge, Simon

AU - Cooklin, Michael

AU - O'Neill, Mark

AU - Wright, Matthew

AU - Gill, Jaswinder

AU - Chiribiri, Amedeo

AU - Schaeffter, Tobias

AU - Carr-White, Gerry

AU - Razavi, Reza

AU - Rinaldi, C Aldo

N1 - This article is protected by copyright. All rights reserved.

PY - 2015/10/14

Y1 - 2015/10/14

N2 - INTRODUCTION: Many heart failure patients with dyssynchrony do not reverse remodel (RR) in response to cardiac resynchronization therapy (CRT). The presence of focal and diffuse interstitial myocardial fibrosis may explain this high non-response rate. T1 mapping is a new cardiac magnetic resonance imaging (CMR) technique that overcomes the limitations of conventional contrast CMR and provides reliable quantitative assessment of diffuse myocardial fibrosis. The study tested the hypothesis that focal and diffuse fibrosis quantification would correlate with a lack of left ventricular (LV) RR to CRT.METHODS AND RESULTS: In a prospective study of 48 consecutive patients (27 ischemic cardiomyopathy, 21 dilated cardiomyopathy) LV scar burdens were quantified (scar core and gray zone using late gadolinium enhancement LGE CMR; interstitial fibrosis using T1 mapping) before CRT implant. LV RR was defined by a ≥ 15% reduction in LV end-systolic volume 6 months post implant. Twenty-seven (56%) patients were responders with RR. Association between scar quantification and LV RR were assessed using Poisson regression model. Univariate analysis showed that QRS duration/morphology, scar core and gray zone volumes expressed as % of LV mass and extracellular volume index (ECV) (a measure of interstitial fibrosis from T1 mapping) to be significant predictors of LV RR. Multivariable-adjusted analyses demonstrated scar core quantification (≥13.7% LVmass) to be the only independent predictor of LV RR (Prevalence ratio 0.40, p = 0.038).CONCLUSIONS: Focal scar burden detected by LGE CMR is associated with a poor response to CRT. Diffuse interstitial fibrosis assessment by T1 mapping however is not independently predictive of CRT response. This article is protected by copyright. All rights reserved.

AB - INTRODUCTION: Many heart failure patients with dyssynchrony do not reverse remodel (RR) in response to cardiac resynchronization therapy (CRT). The presence of focal and diffuse interstitial myocardial fibrosis may explain this high non-response rate. T1 mapping is a new cardiac magnetic resonance imaging (CMR) technique that overcomes the limitations of conventional contrast CMR and provides reliable quantitative assessment of diffuse myocardial fibrosis. The study tested the hypothesis that focal and diffuse fibrosis quantification would correlate with a lack of left ventricular (LV) RR to CRT.METHODS AND RESULTS: In a prospective study of 48 consecutive patients (27 ischemic cardiomyopathy, 21 dilated cardiomyopathy) LV scar burdens were quantified (scar core and gray zone using late gadolinium enhancement LGE CMR; interstitial fibrosis using T1 mapping) before CRT implant. LV RR was defined by a ≥ 15% reduction in LV end-systolic volume 6 months post implant. Twenty-seven (56%) patients were responders with RR. Association between scar quantification and LV RR were assessed using Poisson regression model. Univariate analysis showed that QRS duration/morphology, scar core and gray zone volumes expressed as % of LV mass and extracellular volume index (ECV) (a measure of interstitial fibrosis from T1 mapping) to be significant predictors of LV RR. Multivariable-adjusted analyses demonstrated scar core quantification (≥13.7% LVmass) to be the only independent predictor of LV RR (Prevalence ratio 0.40, p = 0.038).CONCLUSIONS: Focal scar burden detected by LGE CMR is associated with a poor response to CRT. Diffuse interstitial fibrosis assessment by T1 mapping however is not independently predictive of CRT response. This article is protected by copyright. All rights reserved.

U2 - 10.1111/jce.12855

DO - 10.1111/jce.12855

M3 - Article

C2 - 26463874

SN - 1045-3873

JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

ER -