Abstract 19118: Cardiac Resynchronization Therapy Guided by Late Gadolinium-Enhancement Cardiovascular Magnetic Resonance
Introduction: Myocardial scarring at the left ventricular (LV) pacing site leads to incomplete resynchronization and a suboptimal symptomatic response to CRT.
Hypothesis: Using late gadolinium cardiovascular magnetic resonance (LGE-CMR) to guide left ventricular (LV) lead deployment does not influence 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.
Conclusion: 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.
- © 2010 by American Heart Association, Inc.