Relationship between vectorcardiographic QRSarea, myocardial scar quantification, and response to Cardiac Resynchronization Therapy: Vectorcardiography and cardiac magnetic resonance imaging defined scar

TY - JOUR

T1 - Relationship between vectorcardiographic QRSarea, myocardial scar quantification, and response to Cardiac Resynchronization Therapy

T2 - Vectorcardiography and cardiac magnetic resonance imaging defined scar

AU - Nguyen, Uyen

AU - Claridge, Simon

AU - Vernooy, Kevin

AU - Engels, Elien

AU - Razavi, Reza

AU - Rinaldi, Christopher Aldo

AU - Chen, Zhong

AU - Prinzen, Frits

PY - 2018/2/8

Y1 - 2018/2/8

N2 - Purpose: To investigate the relationship between vectorcardiography (VCG) and myocardial scar on cardiac magnetic resonance (CMR) imaging, and whether combining these metrics may improve cardiac resynchronization therapy (CRT) response prediction. Methods: Thirty-three CRT patients were included. QRSarea, Tarea and QRSTarea were derived from the ECG-synthesized VCG. CMR parameters reflecting focal scar core (Scar2SD, Gray2SD) and diffuse fibrosis (pre-T1, extracellular volume [ECV]) were assessed. CRT response was defined as ≥15% reduction in left ventricular end-systolic volume after six months’ follow-up.Results: VCG QRSarea, Tarea and QRSTarea inversely correlated with focal scar (R=-0.44–-0.58 for Scar2SD, p≤0.010), but not with diffuse fibrosis. Scar2SD, Gray2SD and QRSarea predicted CRT response with AUCs of 0.692 (p=0.063), 0.759 (p=0.012) and 0.737 (p=0.022) respectively. A combined ROC-derived threshold for Scar2SD and QRSarea resulted in 92% CRT response rate for patients with large QRSarea and small Scar2SD or Gray2SD. Conclusion: Incremental predictive value for CRT response is achieved by a combined CMR-QRSarea analysis.

AB - Purpose: To investigate the relationship between vectorcardiography (VCG) and myocardial scar on cardiac magnetic resonance (CMR) imaging, and whether combining these metrics may improve cardiac resynchronization therapy (CRT) response prediction. Methods: Thirty-three CRT patients were included. QRSarea, Tarea and QRSTarea were derived from the ECG-synthesized VCG. CMR parameters reflecting focal scar core (Scar2SD, Gray2SD) and diffuse fibrosis (pre-T1, extracellular volume [ECV]) were assessed. CRT response was defined as ≥15% reduction in left ventricular end-systolic volume after six months’ follow-up.Results: VCG QRSarea, Tarea and QRSTarea inversely correlated with focal scar (R=-0.44–-0.58 for Scar2SD, p≤0.010), but not with diffuse fibrosis. Scar2SD, Gray2SD and QRSarea predicted CRT response with AUCs of 0.692 (p=0.063), 0.759 (p=0.012) and 0.737 (p=0.022) respectively. A combined ROC-derived threshold for Scar2SD and QRSarea resulted in 92% CRT response rate for patients with large QRSarea and small Scar2SD or Gray2SD. Conclusion: Incremental predictive value for CRT response is achieved by a combined CMR-QRSarea analysis.

KW - Vectorcardiography

KW - myocardial scar

KW - cardiac magnetic resonance imaging

KW - cardiac resynchronization therapy

UR - http://www.scopus.com/inward/record.url?scp=85041920377&partnerID=8YFLogxK

U2 - 10.1016/j.jelectrocard.2018.01.009

DO - 10.1016/j.jelectrocard.2018.01.009

M3 - Article

SN - 0022-0736

JO - Journal of Electrocardiology

JF - Journal of Electrocardiology

ER -