Cardiac magnetic resonance in patients with cardiac resynchronization therapy: is it time to scan with
Aaron O Koshy1, Peter P P Swoboda1, John Gierula1
1Leeds Institute of Cardiovascular and Metabolic Medicine, Light Laboratories, University of Leeds and Leeds Teaching Hospitals NHS Trust, Clarendon Way, Leeds, UK.
Insights
Cardiac resynchronization therapy (CRT) improves heart failure outcomes. This review explores using cardiac magnetic resonance (CMR) with active CRT, proposing strategies for safe, high-quality imaging to advance research and patient care.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Cardiac resynchronization therapy (CRT) is guideline-recommended for heart failure with reduced ejection fraction and conduction disease.
- Cardiac magnetic resonance (CMR) is optimal for assessing cardiac volumes and function.
- CMR use in CRT patients is limited due to device, programming, and scanning challenges.
Purpose of the Study:
- To review the utility of CMR in patients undergoing CRT.
- To discuss risks and benefits of CMR scanning with active CRT.
- To propose a practical strategy for safe, high-quality CMR in CRT patients.
Main Methods:
- Literature review focusing on CMR utility in CRT patients.
- Analysis of risks and benefits associated with active CRT during CMR.
- Development of a practical scanning strategy.
Main Results:
- CMR offers powerful dynamic assessment of cardiac function, valuable for CRT patients.
- Scanning with active CRT presents challenges but potential benefits for research and outcomes.
- A safe and effective scanning protocol can be implemented.
Conclusions:
- Optimizing CMR imaging in CRT patients requires addressing device limitations.
- Maintaining active CRT during CMR may enhance research and improve patient outcomes.
- Further research and standardized protocols are needed to maximize CMR benefits in this population.
Abstract:
Cardiac resynchronization therapy (CRT) is recommended in international guidelines for patients with heart failure due to important left ventricular systolic dysfunction (or heart failure with reduced ejection fraction) and ventricular conduction tissue disease. Cardiac magnetic resonance (CMR) represents the most powerful imaging tool for dynamic assessment of the volumes and function of cardiac chambers but is rarely utilized in patients with CRT due to limitations on the device, programming and scanning. In this review, we explore the known utility of CMR in this cohort with discussion of the risks and potential benefits of scanning whilst CRT is active, including a practical strategy for conducting high quality scans safely. Our contention is that imaging in patients with CRT could be improved further by keeping resynchronization therapy active with resultant benefits on research and also patient outcomes.
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