Cardiac Resynchronization Therapy in Non-Ischemic Cardiomyopathy: Role of Multimodality Imaging
Abstract
:1. Introduction
2. Cardiac Resynchronization in Cardiomyopathies
3. Multimodality Imaging of Myocardial Dyssynchrony
4. Multimodality Imaging of the Myocardial Substrate
5. Classical Echocardiographic Parameters Useful Pre-CRT
6. Role of Multimodality Imaging for Guiding Lead Positioning
7. Multimodality Imaging for CRT Optimization
8. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Study | Type of Study | Comparison | Inclusion Criteria | No. of Patients | No. of Patients with Non-Ischemic Cardiomyopathy | Primary End-Points | Results Non-Ischemic vs. Ischemic | Conclusions |
---|---|---|---|---|---|---|---|---|
MIRACLE 2002 [6] | RCT | CRT in ischemic vs. non-ischemic | NYHA class III/IV LVEF ≤ 35% QRS ≥ 130 ms LVEDD ≥ 55 mm | 228 | 113 | NYHA class Echo parameters QoL score 6MWT | NYHA class 2.2 ± 0.8 vs. 2.2 ± 0.8 LVEDV, mL, 275 ± 138 vs. 278 ± 87 LVEF, % 33.1 ± 12.6 vs. 29.5 ± 9.9 LV mass, g 301 ± 103 vs. 299 ± 79 QoL score 39 ± 24 vs. 38 ± 23 6MWT, m 342 ± 120 vs. 318 ± 149 | Greater benefit on echocardiographic and clinical parameters in non-ischemic cardiomyopathy |
CARE-HF 2005 [7] | RCT | CRT vs. OMT | NYHA class III/IV LVEF ≤ 35% Cardiac dyssynchronyLVEDD ≥ 30 mm/m2 | 814 | 473 | All-cause mortality or unplanned hospitalization for a major CV event | HR 0.46 (0.35–0.63) vs. 0.71 (0.54–0.94) | Greater benefit on primary end-point in non-ischemic cardiomyopathy |
REVERSE 2008 [8] | RCT | CRT + OMT vs. OMT | NYHA class I/II LVEF ≤ 40% QRS ≥ 120 ms LVEDD ≥ 55 mm | 610 | 183 CRT ON 94 CRT OFF | Echo parameters | LVEDVi, mL/m2 −30.5 vs. −10.7 LVEF, % +7.61 vs. +2.24 LV mass, g −24.1 vs. −11.5 | Greater benefit on echocardiographic parameters in non-ischemic cardiomyopathy |
MADIT–CRT 2009 [9] | RCT | CRT + OMT vs. ICD + OMT | NYHA class I/II LVEF ≤ 30% QRS > 130 ms | 1820 | 774 | Risk of HF or death First HF event Echo parameters | HF or death: 0.56 (0.39–0.80) vs. 0.66 (0.52–0.85) HF event: 0.50 (0.35–0.75) vs. 0.58 (0.45–0.77) LVEDV −24 ± 12% vs. −18 ± 10% LVEF 12 ± 5% vs. 10 ± 5% | Greater benefit on primary end-points in non-ischemic cardiomyopathy |
Application | Echocardiography | CMR | SPECT |
---|---|---|---|
Myocardial dyssynchrony | Filling time/RR distance < 40% Difference between projection time at the aortic and pulmonary level > 40 ms in PWD and 56 ms in TDI Septal flash—septal to posterior wall motion delay in M mode > 130 ms Apical rocking Septal to lateral delay in TDI > 60 ms Max delay in 4 basal LV segments in TDI > 65 ms SD of 6 basal LV segments in TDI > 36.5 ms Max delay in 12 basal and mid-LV segments in TDI > 100 ms SD of 12 basal and mid-LV segments (dyssynchrony index) in TDI > 32.6 ms SD of time-to-peak longitudinal strain in 12 basal and mid-LV segments in TDI color > 60 ms Anteroseptal to posterior time to peak strain difference (radial strain) in 2D speckle tracking > 130 ms SD of time to minimum systolic volume of 16 LV segments (systolic dyssynchrony index) > 5.6% | CMR myocardial tagging (similar to speckle tracking in echocardiography) Phase Contrast Tissue Velocity Mapping (similar to TDI in echocardiography) DENSE—measures strain directly CURE—index of circumferential strain | Timing of regional wall thickening during a cardiac cycle provided by phase analysis—PHD and PSD |
Myocardial substrate | Indicators of transmural scar: GLS < −10%, GRS < −16.5% and GCS > −11.1% LV contractile reserve by dobutamine stress echo | Scar at LV pacing site by late gadolinium enhancement technique | - Scar at LV pacing site by T1 SPECT-MPI |
Lead positioning | Pacing at the latest activation site identified by speckle-tracking echocardiography | Pacing at the latest activation site identified by CMR | Pacing at the latest activation site identified by SPECT |
CRT optimization | AV delay—maximum separation of E and A waves by PWD VV delay—PWD at the level of the LVOT; systolic asynchrony index on 3D echocardiography |
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Stătescu, C.; Ureche, C.; Enachi, Ș.; Radu, R.; Sascău, R.A. Cardiac Resynchronization Therapy in Non-Ischemic Cardiomyopathy: Role of Multimodality Imaging. Diagnostics 2021, 11, 625. https://doi.org/10.3390/diagnostics11040625
Stătescu C, Ureche C, Enachi Ș, Radu R, Sascău RA. Cardiac Resynchronization Therapy in Non-Ischemic Cardiomyopathy: Role of Multimodality Imaging. Diagnostics. 2021; 11(4):625. https://doi.org/10.3390/diagnostics11040625
Chicago/Turabian StyleStătescu, Cristian, Carina Ureche, Ștefana Enachi, Rodica Radu, and Radu A. Sascău. 2021. "Cardiac Resynchronization Therapy in Non-Ischemic Cardiomyopathy: Role of Multimodality Imaging" Diagnostics 11, no. 4: 625. https://doi.org/10.3390/diagnostics11040625