Systolic Dyssynchrony Index derived from cardiac magnetic resonance imaging predicts left ventricular remodeling in hear
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Systolic Dyssynchrony Index derived from cardiac magnetic resonance imaging predicts left ventricular remodeling in heart failure patients undergoing CRT Simon G Duckett1*, Matthew R Ginks1, Anoop K Shetty1, Matthias Paul1, Stam Kapetanakis2, Stephen Sinclair1, Tobias Schaeffter1, C Aldo Rinaldi2, Gerry Carr-White2, Reza Razavi1 From 2011 SCMR/Euro CMR Joint Scientific Sessions Nice, France. 3-6 February 2011 Introduction It is known that 30-40% of heart failure patients that undergo cardiac resynchronization therapy (CRT) do not derive significant clinical benefit. Using cine imaging a measure of volume change over the cardiac cycle can be derived called the Systolic Dyssynchrony Index (SDI). This has the potential to improve patient selection pre CRT. Purpose We assessed the potential of the SDI derived from CMR to predict reduction in end systolic volume (ESV) and improvement in ejection fraction in heart failure patients undergoing CRT. Method 42 heart failure patients (38 male, ejection fraction 26 ±8.9%, NYHA 2.8±0.4), 21 with ischemic cardiomyopathy (ICM) and 21 with dilated cardiomyopathy (DCM) underwent a CMR prior to CRT implantation. Patients were scanned using 1.5T MR-scanner (Achieva, Philips Healthcare, Best, Netherlands) with either 32 or 5-element cardiac coil. Cine steady state free precession (cine-SSFP) images of four, three, two chamber as well as a multiple slice short axis stack were acquired (FA=60°, TR/TE=2.9/1.5ms, resolution 2.2x2.2x10mm, 30 heart phases). Using TomTec 4D LV-Analysis MR (TT4DMR) we derived a 16 segment systolic dyssynchrony index (SDI). 2D echo pre and 6 months post 1
Kings College London, London, UK Full list of author information is available at the end of the article
CRT implantation was used to assess change in EF and ESV. Patients were considered to have remodeled if there was 15% reduction in ESV. Furthermore ≥ 15% improvement in EF was also considered as responding to CRT. An SDI of 10.3% was used to calculate sensitivity and specificities.
Results All patients had a CRT device and were followed up at 6 months. 19 (45%) of the patients had a reduction in ESV ≥ 15% and 22 (52%) had an improvement in EF of ≥ 15%. There was a highly significant relationship between reduction in ESV and SDI (P
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