Rapid Fire Abstracts
Patrick Doeblin, MD
Cardiologist
Deutsches Herzzentrum der Charité, Germany
Patrick Doeblin, MD
Cardiologist
Deutsches Herzzentrum der Charité, Germany
Shing Ching
United Christian Hopsital, Germany
Jeffrey Ji-Peng Li, MD
Student
Charité Universitätsmedizin Berlin, Germany
Stefanie M. Werhahn, MD
Cardiologist
Deutsches Herzzentrum der Charité, Germany
Rebecca E. Beyer, MD
Resident
Deutsches Herzzentrum der Charité, Germany
Misael Estepa, MD
Resident
Deutsches Herzzentrum der Charité, Germany
Christian Stehning, PhD
MRI Physicist
Philips Healthcare, Germany
Djawid Hashemi, MD, MSc
Cardiologist
Deutsches Herzzentrum der Charité, Germany
Natalia Solowjowa, MD
Consultant
Deutsches Herzzentrum der Charité, Germany
Christoph Klein, MD
Consultant
Deutsches Herzzentrum der Charité, Germany
Henryk Dreger, MD
Head of Department
Deutsches Herzzentrum der Charité, Germany
Sebastian Kelle, MD, FSCMR
Cardiologist
Deutsches Herzzentrum der Charité, Germany
Cardiac resynchronization therapy (CRT) is a cornerstone in the treatment of heart failure with left bundle branch block (LBBB) and a left ventricular ejection fraction (LVEF) ≤35%. However, about one third of patients do not respond favorably (with response defined as LV end-systolic volume (LVESV) reduction >=15% at 6-12 months), which is a strong predictor of future adverse events. Echocardiography-derived strain values are variably associated with volumetric response to CRT, while the role of cardiac magnetic resonance (CMR) -derived strain parameters is unexplored. Capitalizing on the advantages of CMR-feature tracking (CMR-FT), the predictive value of these variables was investigated.
Methods:
In this study, 50 patients receiving CRT were retrospectively analysed, all of which had undergone CMR imaging within one year before, and echocardiography within 6 months before and 6-12 months after CRT. CMR scans were performed on 1.5T (Achieva, Philips Healthcare, Best, The Netherlands) and 3T (Ingenia, Philips Healthcare, Best, The Netherlands) scanners with a multi-element phased-array coil. A retrospectively gated balanced steady-state free precession sequence was employed to acquire cine images at the left ventricular short axis and 2-, 3- and 4-chamber-views at a minimum of 25 phases per cardiac cycle. CMR-derived morphological and functional parameters included biventricular volumetry as well as endocardial strain. CRT response was defined as reduction of left ventricular end-systolic volume >=15% after CRT, as measured by echocardiography (CMR was available only before CRT). Strain measurements were performed automatically with manual correction using MEDIS QStrain RE 4.4.
Results:
Responders and non-responders did not differ significantly among baseline parameters (table 1). Among standard CMR parameters, right ventricular end-diastolic (RVEDVi) (74.5 ±19.5 vs. 94.8 ±30.2 ml, P=.006) and left atrial end-systolic area (24.8 ±6.8 vs. 30.4 ±9.5 cm², P=.006) differed significantly between CRT responders and non-responders (Table 2). In strain analysis, CRT responders showed significantly better right ventricular (-24.8 ±6.7 vs. -18.9±7.6, P=.007) and left atrial global longitudinal strain (GLS) (24.7 ±10.6 vs. 15.3 ±10.4, P=.004) (Figure 1). Other strain parameters, including septal and lateral longitudinal strain, were not associated with CRT response.
Conclusion:
CMR-derived right ventricular and left atrial GLS pre-CRT correlated with echocardiographic volumetric response at 6-12 months post-CRT, while left ventricular global, septal and lateral longitudinal strain had no discernible prognostic impact.
