title: Combined dyssynchrony and scar imaging with cardiac magnetic resonance imaging predicts clinical response and long-term prognosis following cardiac resynchronization therapy.
abstract: OBJECTIVE
  Cardiac resynchronization therapy (CRT) is advocated in advanced heart failure; however, patient selection remains challenging. We examined the utility of multi-sequential cardiac magnetic resonance imaging (CMR) in predicting outcome after CRT.
  
  
  RESULTS
  We performed multi-sequential CMR on 40 subjects with cardiomyopathy and advanced heart failure, despite optimized medical therapy. All patients had been recommended for CRT according to accepted clinical guidelines. Patients were defined by CMR as likely responders if they had significant mechanical dyssynchrony (> or =65 ms delay between septal and posterolateral wall contraction on cine imaging), and no transmural scarring of the anteroseptal or posterolateral wall on delayed contrast-enhanced imaging. Clinical composite score was recorded at baseline and 6 months post-CRT. Long-term follow-up (transplant-free survival) was 497 +/- 55 days post-CRT. A clinical response was achieved in 19/26 (73%) of the CMR-predicted responders and 2/12 (17%) of the CMR-predicted non-responders (P < 0.01, chi(2)). The sensitivity of CMR for prediction of clinical response to CRT was 90%, with a specificity of 59%. Transplant-free survival post-CRT was achieved in 88% of the CMR-predicted responders and 58% of the CMR-predicted non-responders (P < 0.05, Kaplan-Meier survival analysis).
  
  
  CONCLUSIONS
  Multi-sequential CMR identifies patients with severe cardiomyopathy who will respond to CRT with a favourable long-term prognosis.
authors.affiliation: Alfred Hospital Heart Centre, Baker IDI Heart and Diabetes Research Institute, Commercial Road, Melbourne, VIC 3004, Australia. andrew.taylor@bakeridi.edu.au
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Taylor
authors.forename: Maros
authors.initials: M
authors.lastname: Elsik
authors.forename: Archer
authors.initials: A
authors.lastname: Broughton
authors.forename: Joshi
authors.initials: J
authors.lastname: Cherayath
authors.forename: Angeline
authors.initials: A
authors.lastname: Leet
authors.forename: Chiew
authors.initials: C
authors.lastname: Wong
authors.forename: Leah
authors.initials: L
authors.lastname: Iles
authors.forename: Michelle
authors.initials: M
authors.lastname: Butler
authors.forename: Heinz
authors.initials: H
authors.lastname: Pfluger
mesh_terms: D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000503:physiopathology*; D002304:Cardiac Pacing, Artificial; D002921:Cicatrix / Q000175:diagnosis / Q000473:pathology*; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D016896:Treatment Outcome