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Cardiac resynchronization therapy guided by multimodality cardiac imaging

Matteo Bertini1, Donato Mele2, Michele Malagù2

  • 1Department of Cardiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy. doc.matber@gmail.com.

European Journal of Heart Failure
|July 14, 2016
PubMed

Insights

A specialized CRT team improved cardiac resynchronization therapy (CRT) response rates by using cardiac magnetic resonance (CMR) and strain imaging to precisely target LV lead placement. This approach significantly increased patient response compared to standard practice.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Heart Failure Management

Background:

  • Cardiac resynchronization therapy (CRT) has suboptimal response rates, with up to 45% of patients not benefiting.
  • Identifying the optimal left ventricular (LV) lead placement is crucial for CRT efficacy.
  • Current standard CRT implantation practices may not consistently identify the ideal pacing target.

Purpose of the Study:

  • To evaluate the effectiveness of a multidisciplinary 'CRT team' in improving CRT response rates.
  • To assess the role of cardiac magnetic resonance (CMR) and longitudinal myocardial strain imaging in guiding LV lead placement.
  • To determine if precise targeting of the most delayed and viable myocardial region enhances CRT outcomes.

Main Methods:

  • A prospective study involving 100 heart failure patients undergoing CRT.
  • Group 1 (n=50) received CRT guided by a 'CRT team' using CMR and strain imaging for LV lead targeting.
  • Group 2 (n=50, control) received CRT via standard clinical practice; response defined as ≥15% reduction in LV end-systolic volume at 6 months.

Main Results:

  • CRT response rates were significantly higher in the 'CRT team' group (78%) compared to the control group (56%, P=0.019).
  • The 'CRT team' identified specific target areas for LV pacing, with concordant lead placement showing a 93.1% response rate.
  • CMR and strain imaging facilitated precise LV lead placement in most patients, guiding targeting to lateral, anterolateral, or posterolateral regions.

Conclusions:

  • Multimodality cardiac imaging, including CMR and strain, is valuable for guiding CRT implantation.
  • Utilizing a dedicated 'CRT team' approach can significantly increase patient response to CRT.
  • Optimizing LV lead positioning through advanced imaging improves CRT efficacy in heart failure patients.
Abstract

Keywords:
Cardiac resynchronization therapyHeart failureLeft ventricular lead position

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