AIM: The influence of location and extent of transmural scar and its relation with dyssynchrony in cardiac resynchronization therapy (CRT) was investigated as posterolateral scar tissue has been invoked as a cause of non-response to CRT. METHODS AND RESULTS: Fifty-seven patients eligible for CRT were assessed for transmural scar with gadolinium-enhanced MRI and for left ventricular (LV) dyssynchrony with tissue Doppler. After implant, both atrioventricular and interventricular pacing intervals were optimized. LV reverse remodeling was defined as >/=10% decrease in LV end-systolic volume after 3 months. Sixteen patients had transmural scar in the posterolateral (PL) area (LV lead location), 14 at a remote site (non-PL) and 27 patients had no scar. LV reverse remodeling was observed in respectively 25%, 64% and 89% (P = 0.0001). Univariate analyses showed a relation with LV dyssynchrony (P = 0.004) and with absence of PL scar (P = 0.04) but not with QRS duration and the extent of LV scar tissue. In multivariate analysis, only LV dyssynchrony (OR: 19.62; 95% CI: 2.5-151.9; P = 0.004) independently predicted LV reverse remodeling. CONCLUSION: In this study LV dyssynchrony remains the most important determinant of response to CRT, even in the presence of posterolateral scar provided atrioventricular and interventricular pacing intervals are optimized.
AIM: The influence of location and extent of transmural scar and its relation with dyssynchrony in cardiac resynchronization therapy (CRT) was investigated as posterolateral scar tissue has been invoked as a cause of non-response to CRT. METHODS AND RESULTS: Fifty-seven patients eligible for CRT were assessed for transmural scar with gadolinium-enhanced MRI and for left ventricular (LV) dyssynchrony with tissue Doppler. After implant, both atrioventricular and interventricular pacing intervals were optimized. LV reverse remodeling was defined as >/=10% decrease in LV end-systolic volume after 3 months. Sixteen patients had transmural scar in the posterolateral (PL) area (LV lead location), 14 at a remote site (non-PL) and 27 patients had no scar. LV reverse remodeling was observed in respectively 25%, 64% and 89% (P = 0.0001). Univariate analyses showed a relation with LV dyssynchrony (P = 0.004) and with absence of PL scar (P = 0.04) but not with QRS duration and the extent of LV scar tissue. In multivariate analysis, only LV dyssynchrony (OR: 19.62; 95% CI: 2.5-151.9; P = 0.004) independently predicted LV reverse remodeling. CONCLUSION: In this study LV dyssynchrony remains the most important determinant of response to CRT, even in the presence of posterolateral scar provided atrioventricular and interventricular pacing intervals are optimized.
Authors: Zainab Samad; Allen E Atchley; Mark A Trimble; Jie-Lena Sun; Linda K Shaw; Robert Pagnanelli; Ji Chen; Ernest V Garcia; Ami E Iskandrian; Eric J Velazquez; Salvador Borges-Neto Journal: J Nucl Cardiol Date: 2010-11-17 Impact factor: 5.952
Authors: Roy C P Kerckhoffs; Sanjiv M Narayan; Jeffrey H Omens; Lawrence J Mulligan; Andrew D McCulloch Journal: Heart Fail Clin Date: 2008-07 Impact factor: 3.179
Authors: Steven A Niederer; A K Shetty; G Plank; J Bostock; R Razavi; N P Smith; C A Rinaldi Journal: Pacing Clin Electrophysiol Date: 2011-10-31 Impact factor: 1.976