Amin Daoulah1, Alawi A Alsheikh-Ali2, Salem M Al-Faifi3, Sara R Ocheltree4, Ejazul Haq5, Farhan M Asrar6, Adnan Fathey5, Ali Ahmed Haneef7, Faris Al Mousily8, El-Sayed O5, Amir Lotfi9. 1. Section of Adult Cardiology, Cardiovascular Department, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia. Electronic address: amindaoulah@yahoo.com. 2. Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Tufts Clinical and Translational Science Institute, Department of Medicine, Tuft University School of Medicine, Boston, MA, USA. 3. Section of Pulmonology, Internal Medicine Department, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia. 4. University of Alabama School of Medicine, Huntsville Regional Medical Campus, Huntsville, AL, USA. 5. Section of Adult Cardiology, Cardiovascular Department, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia. 6. University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada. 7. Division of Cardiothoracic Surgery and Cardiac Surgery Intensive Care Unit, King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia. 8. Section of Pediatric Cardiology, Cardiovascular Department, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia. 9. Division of Cardiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA.
Abstract
BACKGROUND: Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in selected patients with heart failure, but up to one third of patients may not respond to CRT. A transmural postero-lateral (TMPL) wall scar in the left ventricle (LV) or over the LV pacing site may attenuate clinical and echocardiographic response to CRT. METHODS AND RESULTS: We systematically searched PubMed, EMBASE, and Cochrane databases for studies examining the association between Cardiac magnetic resonance (CMR)-determined postero-lateral or LV pacing site scar and clinical and echocardiographic response to CRT. Eleven prospective studies were included. The presence of TMPL scar on pre-implant CMR was associated with a 75% lower chance of echocardiographic response to CRT, and a similarly lower chance of clinical response. Significant scar over LV pacing site on pre-implant CMR was also associated with a 46% lower chance of echocardiographic response to CRT, and a 67% lower chance of clinical response. CONCLUSIONS: The presence of transmural postero-lateral scar or significant scar within the LV pacing site detected by pre-implant CMR is associated with a lower rate of clinical or echocardiographic response to CRT.
BACKGROUND: Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in selected patients with heart failure, but up to one third of patients may not respond to CRT. A transmural postero-lateral (TMPL) wall scar in the left ventricle (LV) or over the LV pacing site may attenuate clinical and echocardiographic response to CRT. METHODS AND RESULTS: We systematically searched PubMed, EMBASE, and Cochrane databases for studies examining the association between Cardiac magnetic resonance (CMR)-determined postero-lateral or LV pacing site scar and clinical and echocardiographic response to CRT. Eleven prospective studies were included. The presence of TMPL scar on pre-implant CMR was associated with a 75% lower chance of echocardiographic response to CRT, and a similarly lower chance of clinical response. Significant scar over LV pacing site on pre-implant CMR was also associated with a 46% lower chance of echocardiographic response to CRT, and a 67% lower chance of clinical response. CONCLUSIONS: The presence of transmural postero-lateral scar or significant scar within the LV pacing site detected by pre-implant CMR is associated with a lower rate of clinical or echocardiographic response to CRT.
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