Abstract 2717: Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Predicts Clinical Events in Patients with Resynchronization Therapy
Background: The predictors of long-term response to cardiac resynchronization therapy (CRT) are not well understood.
Objective: We analyze if late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) predicts long term clinical response (events) in patients treated with CRT
Methods: 60 consecutive patients with implanted TRC devices were included. Before device implantation LGE-CMR was performed, to identify the presence, location and pattern of scar. Total scar burden was assessed using a 17-segment model with a 3 point hyperenhancement scale (0 = no enhancenment; 1 = hyperenhancement less 50%; 2 = hyperenhancement > 50%). Echocardiographic parameters and clinical events (cardiac death or readmission due to heart failure) were evaluated after 499 days follow up (246 –733).
Results: Twenty two patients (36.7%) did not have LGE, 7 (11.6%) had septal fibrosis whereas 31(51.6%) had septal or inferolateral necrosis pattern. There were significant differences among patients in the 3 groups for the composite endpoint of cardiac death and readmission for heart failure (non LGE 9.1%, fibrosis 28.6%, necrosis 45.2% p = 0.012) Patients without LGE showed better systolic function (p = 0.009) and less end-diastolic diameters (p = 0,04) at follow-up compared to patients with LGE . In addition, multivariate analysis identifies scar as the most powerful predictor of lack of response to CRT (HR 10.57, CI 1.2–5.8;p = 0.012) together with the absence of left bundle branch block and LGE score (total scar burden).
Conclusion: The presence and severity of LGE CMR predicts clinical events in patients treated with CRT.