Twelve‐Lead ECG Optimization of Cardiac Resynchronization Therapy in Patients With and Without Delayed Enhancement on Cardiac Magnetic Resonance Imaging
Background Delayed enhancement (DE) on magnetic resonance imaging is associated with ventricular arrhythmias, adverse events, and worse left ventricular mechanics. We investigated the impact of DE on cardiac resynchronization therapy (CRT) outcomes and the effect of CRT optimization. Methods and Res...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2018-12-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.009559 |
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| author | Ryan M. Gage Akbar H. Khan Imran S. Syed Ambareesh Bajpai Kevin V. Burns Antonia E. Curtin Amanda L. Blanchard Jeffrey M. Gillberg Subham Ghosh Alan J. Bank |
| author_facet | Ryan M. Gage Akbar H. Khan Imran S. Syed Ambareesh Bajpai Kevin V. Burns Antonia E. Curtin Amanda L. Blanchard Jeffrey M. Gillberg Subham Ghosh Alan J. Bank |
| author_sort | Ryan M. Gage |
| collection | DOAJ |
| description | Background Delayed enhancement (DE) on magnetic resonance imaging is associated with ventricular arrhythmias, adverse events, and worse left ventricular mechanics. We investigated the impact of DE on cardiac resynchronization therapy (CRT) outcomes and the effect of CRT optimization. Methods and Results We studied 130 patients with ejection fraction (EF) ≤40% and QRS ≥120 ms, contrast cardiac magnetic resonance imaging, and both pre‐ and 1‐year post‐CRT echocardiograms. Sixty‐three (48%) patients did not have routine optimization of CRT. The remaining patients were optimized for wavefront fusion by 12‐lead ECG. The primary end point in this study was change in EF following CRT. To investigate the association between electrical dyssynchrony and EF outcomes, the standard deviation of activation times from body‐surface mapping was calculated during native conduction and selected device settings in 52 of the optimized patients. Patients had no DE (n=45), midwall septal stripe (n=30), or scar (n=55). Patients without DE had better ∆EF (13±10 versus 4±10 units; P<0.01). Optimized patients had greater ∆EF in midwall stripe (2±9 versus 12±12 units; P=0.01) and scar (0±7 versus 5±10; P=0.04) groups, but not in the no‐DE group. Patients without DE had greater native standard deviation of activation times (P=0.03) and greater ∆standard deviation of activation times with standard programming (P=0.01). Device optimization reduced standard deviation of activation times only in patients with DE (P<0.01). Conclusions DE on magnetic resonance imaging is associated with worse EF outcomes following CRT. Device optimization is associated with improved EF and reduced electrical dyssynchrony in patients with DE. |
| first_indexed | 2024-12-23T04:53:58Z |
| format | Article |
| id | doaj.art-66608f0854e2426e8699ee611db684b9 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-23T04:53:58Z |
| publishDate | 2018-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-66608f0854e2426e8699ee611db684b92022-12-21T17:59:23ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-12-0172310.1161/JAHA.118.009559Twelve‐Lead ECG Optimization of Cardiac Resynchronization Therapy in Patients With and Without Delayed Enhancement on Cardiac Magnetic Resonance ImagingRyan M. Gage0Akbar H. Khan1Imran S. Syed2Ambareesh Bajpai3Kevin V. Burns4Antonia E. Curtin5Amanda L. Blanchard6Jeffrey M. Gillberg7Subham Ghosh8Alan J. Bank9United Heart & Vascular Clinic St. Paul MNUnited Heart & Vascular Clinic St. Paul MNUnited Heart & Vascular Clinic St. Paul MNUnited Heart & Vascular Clinic St. Paul MNUnited Heart & Vascular Clinic St. Paul MNDepartment of Biomedical Engineering University of Minnesota Minneapolis MNAbbott Northwestern Hospital Minneapolis MNMedtronic, CRHF Mounds View MNMedtronic, CRHF Mounds View MNUnited Heart & Vascular Clinic St. Paul MNBackground Delayed enhancement (DE) on magnetic resonance imaging is associated with ventricular arrhythmias, adverse events, and worse left ventricular mechanics. We investigated the impact of DE on cardiac resynchronization therapy (CRT) outcomes and the effect of CRT optimization. Methods and Results We studied 130 patients with ejection fraction (EF) ≤40% and QRS ≥120 ms, contrast cardiac magnetic resonance imaging, and both pre‐ and 1‐year post‐CRT echocardiograms. Sixty‐three (48%) patients did not have routine optimization of CRT. The remaining patients were optimized for wavefront fusion by 12‐lead ECG. The primary end point in this study was change in EF following CRT. To investigate the association between electrical dyssynchrony and EF outcomes, the standard deviation of activation times from body‐surface mapping was calculated during native conduction and selected device settings in 52 of the optimized patients. Patients had no DE (n=45), midwall septal stripe (n=30), or scar (n=55). Patients without DE had better ∆EF (13±10 versus 4±10 units; P<0.01). Optimized patients had greater ∆EF in midwall stripe (2±9 versus 12±12 units; P=0.01) and scar (0±7 versus 5±10; P=0.04) groups, but not in the no‐DE group. Patients without DE had greater native standard deviation of activation times (P=0.03) and greater ∆standard deviation of activation times with standard programming (P=0.01). Device optimization reduced standard deviation of activation times only in patients with DE (P<0.01). Conclusions DE on magnetic resonance imaging is associated with worse EF outcomes following CRT. Device optimization is associated with improved EF and reduced electrical dyssynchrony in patients with DE.https://www.ahajournals.org/doi/10.1161/JAHA.118.009559body surface mappingcardiac magnetic resonance imagingcardiac resynchronization therapyheart failureoutcome |
| spellingShingle | Ryan M. Gage Akbar H. Khan Imran S. Syed Ambareesh Bajpai Kevin V. Burns Antonia E. Curtin Amanda L. Blanchard Jeffrey M. Gillberg Subham Ghosh Alan J. Bank Twelve‐Lead ECG Optimization of Cardiac Resynchronization Therapy in Patients With and Without Delayed Enhancement on Cardiac Magnetic Resonance Imaging Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease body surface mapping cardiac magnetic resonance imaging cardiac resynchronization therapy heart failure outcome |
| title | Twelve‐Lead ECG Optimization of Cardiac Resynchronization Therapy in Patients With and Without Delayed Enhancement on Cardiac Magnetic Resonance Imaging |
| title_full | Twelve‐Lead ECG Optimization of Cardiac Resynchronization Therapy in Patients With and Without Delayed Enhancement on Cardiac Magnetic Resonance Imaging |
| title_fullStr | Twelve‐Lead ECG Optimization of Cardiac Resynchronization Therapy in Patients With and Without Delayed Enhancement on Cardiac Magnetic Resonance Imaging |
| title_full_unstemmed | Twelve‐Lead ECG Optimization of Cardiac Resynchronization Therapy in Patients With and Without Delayed Enhancement on Cardiac Magnetic Resonance Imaging |
| title_short | Twelve‐Lead ECG Optimization of Cardiac Resynchronization Therapy in Patients With and Without Delayed Enhancement on Cardiac Magnetic Resonance Imaging |
| title_sort | twelve lead ecg optimization of cardiac resynchronization therapy in patients with and without delayed enhancement on cardiac magnetic resonance imaging |
| topic | body surface mapping cardiac magnetic resonance imaging cardiac resynchronization therapy heart failure outcome |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.009559 |
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