Comparison between cardiac magnetic resonance and speckle-tracking echocardiography in prediction of cardiac resynchronization therapy outcomes
Background Cardiac resynchronization therapy (CRT) improves quality of life, exercise tolerance, and myocardial function in a considerable number of patients with heart failure (HF) and left bundle branch block. In addition, CRT decreases HF hospitalizations and overall mortality. However, structura...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2021-01-01
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| Series: | Al-Azhar Assiut Medical Journal |
| Subjects: | |
| Online Access: | http://www.azmj.eg.net/article.asp?issn=1687-1693;year=2021;volume=19;issue=2;spage=237;epage=249;aulast=Khedrawy |
| _version_ | 1819100244999143424 |
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| author | Mohamd Bahaa Elden Mohamed Khedrawy Mohamed Salah El-Din Abdel Salam Mohamed Mahmud Ahmed Wesam Emam Ali Elmozy |
| author_facet | Mohamd Bahaa Elden Mohamed Khedrawy Mohamed Salah El-Din Abdel Salam Mohamed Mahmud Ahmed Wesam Emam Ali Elmozy |
| author_sort | Mohamd Bahaa Elden Mohamed Khedrawy |
| collection | DOAJ |
| description | Background Cardiac resynchronization therapy (CRT) improves quality of life, exercise tolerance, and myocardial function in a considerable number of patients with heart failure (HF) and left bundle branch block. In addition, CRT decreases HF hospitalizations and overall mortality. However, structural, morbidity, and mortality improvements after CRT rate between 40 and 60%.
Objective To compare the role of the cardiac magnetic resonance (CMR) and speckle-tracking echocardiography (STE) in expectation of response to CRT.
Patients and methods We investigated the predictors of CRT response using CMR measurement of left ventricular (LV) volumes and function, CMR-derived mechanical dyssynchrony, scar percentage, and its relation to the site of LV lead implantation, in comparison with STE in prediction of CRT outcomes.
Results A total of 35 patients with HF planned for CRT were included. Echocardiography was used to define the response to CRT (15% reduction in LV end-systolic volume 6 months after implantation). At follow-up, 18 (51.43%) patients were categorized as responders. Echocardiographic speckle-tracking radial strain analysis showed a significant LV dyssynchrony in responders versus nonresponders (radial mid-anteroseptal and posterior wall delays were 245.1 ms and 80.7 ms, respectively) (P<0.0001). LV radial dyssynchrony, as measured by CMR-feature tracking, was significantly higher in responders versus nonresponders (mean of SDt-16 of radial strain were 232.7 ms vs. 180.4 ms, P<0.0001), and median of radial mid-anteroseptal-to-inferolateral wall delay was 375 vs. 125.4 ms, P<0.0001). Late contrast-enhanced CMR was performed for scar assessment. It was noticed that scar percentage of LV mass was much higher in nonresponders (median 6.2 vs. 0%) (P=0.005).
Conclusion CMR imaging offers the unique opportunity to predict the CRT outcomes by measurement of LV volumes, LV mechanical dyssynchrony (that well correlated with that of STE), and the total scar percentage and distribution in a single examination. |
| first_indexed | 2024-12-22T00:59:42Z |
| format | Article |
| id | doaj.art-57abeb8e6a3f49d19e4d2332741ee837 |
| institution | Directory Open Access Journal |
| issn | 1687-1693 |
| language | English |
| last_indexed | 2024-12-22T00:59:42Z |
| publishDate | 2021-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Al-Azhar Assiut Medical Journal |
| spelling | doaj.art-57abeb8e6a3f49d19e4d2332741ee8372022-12-21T18:44:14ZengWolters Kluwer Medknow PublicationsAl-Azhar Assiut Medical Journal1687-16932021-01-0119223724910.4103/AZMJ.AZMJ_107_20Comparison between cardiac magnetic resonance and speckle-tracking echocardiography in prediction of cardiac resynchronization therapy outcomesMohamd Bahaa Elden Mohamed KhedrawyMohamed Salah El-Din Abdel SalamMohamed Mahmud AhmedWesam Emam Ali ElmozyBackground Cardiac resynchronization therapy (CRT) improves quality of life, exercise tolerance, and myocardial function in a considerable number of patients with heart failure (HF) and left bundle branch block. In addition, CRT decreases HF hospitalizations and overall mortality. However, structural, morbidity, and mortality improvements after CRT rate between 40 and 60%. Objective To compare the role of the cardiac magnetic resonance (CMR) and speckle-tracking echocardiography (STE) in expectation of response to CRT. Patients and methods We investigated the predictors of CRT response using CMR measurement of left ventricular (LV) volumes and function, CMR-derived mechanical dyssynchrony, scar percentage, and its relation to the site of LV lead implantation, in comparison with STE in prediction of CRT outcomes. Results A total of 35 patients with HF planned for CRT were included. Echocardiography was used to define the response to CRT (15% reduction in LV end-systolic volume 6 months after implantation). At follow-up, 18 (51.43%) patients were categorized as responders. Echocardiographic speckle-tracking radial strain analysis showed a significant LV dyssynchrony in responders versus nonresponders (radial mid-anteroseptal and posterior wall delays were 245.1 ms and 80.7 ms, respectively) (P<0.0001). LV radial dyssynchrony, as measured by CMR-feature tracking, was significantly higher in responders versus nonresponders (mean of SDt-16 of radial strain were 232.7 ms vs. 180.4 ms, P<0.0001), and median of radial mid-anteroseptal-to-inferolateral wall delay was 375 vs. 125.4 ms, P<0.0001). Late contrast-enhanced CMR was performed for scar assessment. It was noticed that scar percentage of LV mass was much higher in nonresponders (median 6.2 vs. 0%) (P=0.005). Conclusion CMR imaging offers the unique opportunity to predict the CRT outcomes by measurement of LV volumes, LV mechanical dyssynchrony (that well correlated with that of STE), and the total scar percentage and distribution in a single examination.http://www.azmj.eg.net/article.asp?issn=1687-1693;year=2021;volume=19;issue=2;spage=237;epage=249;aulast=Khedrawycardiac magnetic resonancecardiac resynchronization therapyfeature tracking |
| spellingShingle | Mohamd Bahaa Elden Mohamed Khedrawy Mohamed Salah El-Din Abdel Salam Mohamed Mahmud Ahmed Wesam Emam Ali Elmozy Comparison between cardiac magnetic resonance and speckle-tracking echocardiography in prediction of cardiac resynchronization therapy outcomes Al-Azhar Assiut Medical Journal cardiac magnetic resonance cardiac resynchronization therapy feature tracking |
| title | Comparison between cardiac magnetic resonance and speckle-tracking echocardiography in prediction of cardiac resynchronization therapy outcomes |
| title_full | Comparison between cardiac magnetic resonance and speckle-tracking echocardiography in prediction of cardiac resynchronization therapy outcomes |
| title_fullStr | Comparison between cardiac magnetic resonance and speckle-tracking echocardiography in prediction of cardiac resynchronization therapy outcomes |
| title_full_unstemmed | Comparison between cardiac magnetic resonance and speckle-tracking echocardiography in prediction of cardiac resynchronization therapy outcomes |
| title_short | Comparison between cardiac magnetic resonance and speckle-tracking echocardiography in prediction of cardiac resynchronization therapy outcomes |
| title_sort | comparison between cardiac magnetic resonance and speckle tracking echocardiography in prediction of cardiac resynchronization therapy outcomes |
| topic | cardiac magnetic resonance cardiac resynchronization therapy feature tracking |
| url | http://www.azmj.eg.net/article.asp?issn=1687-1693;year=2021;volume=19;issue=2;spage=237;epage=249;aulast=Khedrawy |
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