Cardiac resynchronization therapy guided by late gadolinium-enhancement cardiovascular magnetic resonance

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Cardiac resynchronization therapy guided by late gadolinium-enhancement cardiovascular magnetic resonance. / Leyva, F; Foley, PWX; Chalil, S; Ratib, Karim; Smith, Russell; Prinzen, F; Auricchio, A.

In: Journal of Cardiovascular Magnetic Resonance, Vol. 13, 01.06.2011, p. 29.

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Leyva, F ; Foley, PWX ; Chalil, S ; Ratib, Karim ; Smith, Russell ; Prinzen, F ; Auricchio, A. / Cardiac resynchronization therapy guided by late gadolinium-enhancement cardiovascular magnetic resonance. In: Journal of Cardiovascular Magnetic Resonance. 2011 ; Vol. 13. pp. 29.

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@article{9f03a1f06e5e47b4bf503b87c6bbad80,
title = "Cardiac resynchronization therapy guided by late gadolinium-enhancement cardiovascular magnetic resonance",
abstract = "Background: Myocardial 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). Methods: 559 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). Results: Over 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. Conclusions: Compared 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.",
author = "F Leyva and PWX Foley and S Chalil and Karim Ratib and Russell Smith and F Prinzen and A Auricchio",
year = "2011",
month = jun,
day = "1",
doi = "10.1186/1532-429X-13-29",
language = "English",
volume = "13",
pages = "29",
journal = "Journal of Cardiovascular Magnetic Resonance",
issn = "1097-6647",
publisher = "Springer",

}

RIS

TY - JOUR

T1 - Cardiac resynchronization therapy guided by late gadolinium-enhancement cardiovascular magnetic resonance

AU - Leyva, F

AU - Foley, PWX

AU - Chalil, S

AU - Ratib, Karim

AU - Smith, Russell

AU - Prinzen, F

AU - Auricchio, A

PY - 2011/6/1

Y1 - 2011/6/1

N2 - Background: Myocardial 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). Methods: 559 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). Results: Over 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. Conclusions: Compared 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.

AB - Background: Myocardial 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). Methods: 559 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). Results: Over 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. Conclusions: Compared 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.

U2 - 10.1186/1532-429X-13-29

DO - 10.1186/1532-429X-13-29

M3 - Article

C2 - 21668964

VL - 13

SP - 29

JO - Journal of Cardiovascular Magnetic Resonance

JF - Journal of Cardiovascular Magnetic Resonance

SN - 1097-6647

ER -