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

Research output: Contribution to journalArticle

Uyen Nguyen, Simon Claridge, Kevin Vernooy, Elien Engels, Reza Razavi, Christopher Aldo Rinaldi, Zhong Chen, Frits Prinzen

Original languageEnglish
JournalJournal of Electrocardiology
Early online date8 Feb 2018
Publication statusE-pub ahead of print - 8 Feb 2018


King's Authors


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.

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