PURPOSE: Myocardial scar is an adverse factor when considering which patients are likely to respond to cardiac resynchronisation therapy (CRT). We hypothesized that septal scarring on magnetic resonance imaging (MRI) may be associated with a poor outcome from CRT, which may relate to the inability to place the right ventricular (RV) lead in the septum. METHODS: Fifty patients (ejection fractions, 25 ± 8%; 45 men, 62.8 ± 14 years; 26 dilated cardiomyopathy; and 24 ischaemic cardiomyopathy (ICM)) receiving CRT underwent delayed enhancement cardiac MRI to assess location and burden of myocardial scar. Acute hemodynamic response (AHR) was evaluated at implant with a pressure wire in the left ventricular (LV) cavity. LV remodelling was determined by reduction in LV end-systolic volume at 6 months. RESULTS: The presence of ICM with septal scar was associated with a poor acute and chronic response to CRT. This was predominantly due to a worse response in patients with septal scar. Patients without septal scar had a better AHR with a 26.7 ± 28.9% rise in LV dP/dt (max) from baseline vs. -2.8 ± 14.5% for patients with septal scar (P = 0.01) with Biventricular (BIV) pacing. A greater proportion remodelled (56% vs. 20% (P = 0.02)). Furthermore, only 33% of patients with septal scar had an RV septal lead compared with 66% with no septal scar (P = 0.03). CONCLUSIONS: The presence of septal scar was associated with a poor acute and chronic response to CRT. This may relate to the inability to achieve a RV septal lead placement.
PURPOSE: Myocardial scar is an adverse factor when considering which patients are likely to respond to cardiac resynchronisation therapy (CRT). We hypothesized that septal scarring on magnetic resonance imaging (MRI) may be associated with a poor outcome from CRT, which may relate to the inability to place the right ventricular (RV) lead in the septum. METHODS: Fifty patients (ejection fractions, 25 ± 8%; 45 men, 62.8 ± 14 years; 26 dilated cardiomyopathy; and 24 ischaemic cardiomyopathy (ICM)) receiving CRT underwent delayed enhancement cardiac MRI to assess location and burden of myocardial scar. Acute hemodynamic response (AHR) was evaluated at implant with a pressure wire in the left ventricular (LV) cavity. LV remodelling was determined by reduction in LV end-systolic volume at 6 months. RESULTS: The presence of ICM with septal scar was associated with a poor acute and chronic response to CRT. This was predominantly due to a worse response in patients with septal scar. Patients without septal scar had a better AHR with a 26.7 ± 28.9% rise in LV dP/dt (max) from baseline vs. -2.8 ± 14.5% for patients with septal scar (P = 0.01) with Biventricular (BIV) pacing. A greater proportion remodelled (56% vs. 20% (P = 0.02)). Furthermore, only 33% of patients with septal scar had an RV septal lead compared with 66% with no septal scar (P = 0.03). CONCLUSIONS: The presence of septal scar was associated with a poor acute and chronic response to CRT. This may relate to the inability to achieve a RV septal lead placement.
Authors: Shajil Chalil; Paul W X Foley; Sarkaw A Muyhaldeen; Kiran C R Patel; Zaheer R Yousef; Russell E A Smith; Michael P Frenneaux; Francisco Leyva Journal: Europace Date: 2007-10-12 Impact factor: 5.214
Authors: Jeroen J Bax; Gabe B Bleeker; Thomas H Marwick; Sander G Molhoek; Eric Boersma; Paul Steendijk; Ernst E van der Wall; Martin J Schalij Journal: J Am Coll Cardiol Date: 2004-11-02 Impact factor: 24.094
Authors: Nicolas Derval; Paul Steendijk; Lorne J Gula; Antoine Deplagne; Julien Laborderie; Frederic Sacher; Sebastien Knecht; Matthew Wright; Isabelle Nault; Sylvain Ploux; Philippe Ritter; Pierre Bordachar; Stephane Lafitte; Patricia Réant; George J Klein; Sanjiv M Narayan; Stephane Garrigue; Mélèze Hocini; Michel Haissaguerre; Jacques Clementy; Pierre Jaïs Journal: J Am Coll Cardiol Date: 2009-11-20 Impact factor: 24.094
Authors: S Chalil; B Stegemann; S A Muhyaldeen; K Khadjooi; P W Foley; R E A Smith; F Leyva Journal: Pacing Clin Electrophysiol Date: 2007-10 Impact factor: 1.976
Authors: A L A J Dekker; B Phelps; B Dijkman; T van der Nagel; F H van der Veen; G G Geskes; J G Maessen Journal: J Thorac Cardiovasc Surg Date: 2004-06 Impact factor: 5.209
Authors: C Leclercq; S Cazeau; H Le Breton; P Ritter; P Mabo; D Gras; D Pavin; A Lazarus; J C Daubert Journal: J Am Coll Cardiol Date: 1998-12 Impact factor: 24.094
Authors: Gabe B Bleeker; Theodorus A M Kaandorp; Hildo J Lamb; Eric Boersma; Paul Steendijk; Albert de Roos; Ernst E van der Wall; Martin J Schalij; Jeroen J Bax Journal: Circulation Date: 2006-02-13 Impact factor: 29.690
Authors: C Tobon-Gomez; N Duchateau; R Sebastian; S Marchesseau; O Camara; E Donal; M De Craene; A Pashaei; J Relan; M Steghofer; P Lamata; H Delingette; S Duckett; M Garreau; A Hernandez; K S Rhode; M Sermesant; N Ayache; C Leclercq; R Razavi; N P Smith; A F Frangi Journal: Med Biol Eng Comput Date: 2013-02-21 Impact factor: 2.602
Authors: George Bazoukis; Jeremy Man Ho Hui; Yan Hiu Athena Lee; Oscar Hou In Chou; Dimitrios Sfairopoulos; Konstantinos Vlachos; Athanasios Saplaouras; Konstantinos P Letsas; Michael Efremidis; Gary Tse; Vassilios S Vassiliou; Panagiotis Korantzopoulos Journal: Heart Fail Rev Date: 2022-08-31 Impact factor: 4.654
Authors: Jonathan D Suever; Gregory R Hartlage; R Patrick Magrath; Shahriar Iravanian; Michael S Lloyd; John N Oshinski Journal: J Cardiovasc Magn Reson Date: 2014-01-06 Impact factor: 5.364