Cardiac resynchronization therapy guided by late gadolinium-enhancement cardiovascular magnetic resonanceReport as inadecuate

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Journal of Cardiovascular Magnetic Resonance

, 13:29

First Online: 13 June 2011Received: 08 September 2010Accepted: 13 June 2011


BackgroundMyocardial scarring at the LV pacing site leads to incomplete resynchronization and a suboptimal symptomatic response to CRT. We sought to determine whether the use of late gadolinium cardiovascular magnetic resonance LGE-CMR to guide left ventricular LV lead deployment influences the long-term outcome of cardiac resynchronization therapy CRT.

Methods559 patients with heart failure age 70.4 ± 10.7 yrs mean ± SD due to ischemic or non-ischemic cardiomyopathy underwent CRT. Implantations were either guided +CMR or not guided -CMR by LGE-CMR prior to implantation. Fluoroscopy and LGE-CMR were used to localize the LV lead tip and and myocardial scarring retrospectively. Clinical events were assessed in three groups: +CMR and pacing scar +CMR+S; CMR and not pacing scar +CMR-S, and; LV pacing not guided by CMR -CMR.

ResultsOver a maximum follow-up of 9.1 yrs, +CMR+S had the highest risk of cardiovascular death HR: 6.34, cardiovascular death or hospitalizations for heart failure HR: 5.57 and death from any cause or hospitalizations for major adverse cardiovascular events HR: 4.74 all P < 0.0001, compared with +CMR-S. An intermediate risk of meeting these endpoints was observed for -CMR, with HRs of 1.51 P = 0.0726, 1.61 P = 0.0169 and 1.87 p = 0.0005, respectively. The +CMR+S group had the highest risk of death from pump failure HR: 5.40, p < 0.0001 and sudden cardiac death HR: 4.40, p = 0.0218, in relation to the +CMR-S group.

ConclusionsCompared with a conventional implantation approach, the use of LGE-CMR to guide LV lead deployment away from scarred myocardium results in a better clinical outcome after CRT. Pacing scarred myocardium was associated with the worst outcome, in terms of both pump failure and sudden cardiac death.

Electronic supplementary materialThe online version of this article doi:10.1186-1532-429X-13-29 contains supplementary material, which is available to authorized users.

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Author: Francisco Leyva - Paul WX Foley - Shajil Chalil - Karim Ratib - Russell EA Smith - Frits Prinzen - Angelo Auricchio


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