Prediction of Cardiac Resynchronization Therapy Response in Dilated Cardiomyopathy Using Vortex Flow Mapping on Cine...

Area of Science:

• Cardiology
• Medical Imaging
• Biomedical Engineering

Background:

• Dilated cardiomyopathy (DCM) and heart failure (HF) are associated with impaired left ventricular (LV) function.
• Cardiac resynchronization therapy (CRT) is a treatment option for eligible HF patients.
• Predicting CRT response remains a challenge, necessitating novel imaging biomarkers.

Purpose of the Study:

• To investigate the association between left ventricle ejection fraction (LVEF) and vortex flow (VF).
• To determine if VF mapping (VFM) can predict CRT response in patients with DCM.
• To evaluate the relationship between VF and major adverse cardiac events (MACE) post-CRT.

Main Methods:

• Retrospective analysis of cardiac magnetic resonance imaging (CMR) data from 45 patients (20 HF with LVEF ≥40%, 25 DCM with LVEF <40%) scheduled for CRT.
• Calculation of maximum vortex flow (MVF) using VFM on LV cine imaging (short-axis, long-axis, 4-chamber views).
• Summed MVF was used as a representative value; CRT response and MACE were assessed during follow-up.

Main Results:

• Summed MVF was significantly higher in DCM patients compared to HF patients with preserved LVEF (25.2±19.2% vs. 12.1±15.4%, P<0.005).
• Summed MVF was significantly greater in CRT responders (35.8±22.7%) than in non-responders (15.8±8.7%, P=0.04).
• Patients with summed MVF ≥31.3% had a significantly higher MACE-free rate (log-rank=4.51, P<0.05).

Conclusions:

• LV vortex flow is disrupted in heart failure, impacting efficient ejection.
• Summed MVF derived from VFM is a promising predictor of CRT response in DCM.
• VFM analysis of VF may aid in patient selection for CRT and risk stratification.