title: Cardiac resynchronization therapy guided by multimodality cardiac imaging.
abstract: Up to 30-45% of implanted patients are non-responders to CRT. We evaluated the role of a 'CRT team' using cardiac magnetic resonance (CMR) and longitudinal myocardial strain to identify the target area defined as the most delayed and viable region for LV pacing.
  
  
  
  A total of 100 heart failure patients candidates for CRT divided into two groups were enrolled. Group 1 consisted of 50 consecutive patients scheduled for CRT and prospectively included. Group 2 (control) consisted of 50 patients with a CRT device implanted according to standard clinical practice and matched for age, sex, and LVEF with group 1. Patients were evaluated at baseline and at 6-month follow-up. In group 1, patients underwent two-dimensional speckle-tracking assessment of longitudinal myocardial strain and CMR imaging to identify the target area for LV lead pacing. A positive response to CRT was defined as a reduction of ≥15% of the LV end-systolic volume at 6-month follow-up. A total of 39 (78%) patients of group 1 were classified as responders to CRT whilst in group 2, only 28 (56%) were responders (P = 0.019). The 'CRT team' identified as target for LV pacing the lateral area in 30 (60%) patients, and the anterolateral or posterolateral areas in 12 (24%) patients. In 8 (16%) patients, the target was far from the lateral area, in the anterior or posterior areas. The patients with concordant position exhibited the highest positive response (93.1%) to CRT.
  
  
  
  Multimodality cardiac imaging as a guide for CRT implantation is useful to increase response rate.
authors.affiliation: Department of Cardiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy. doc.matber@gmail.com.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bertini
authors.affiliation: Department of Cardiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy.
authors.forename: Donato
authors.initials: D
authors.lastname: Mele
authors.affiliation: Department of Cardiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Malagù
authors.affiliation: Department of Cardiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fiorencis
authors.affiliation: Department of Cardiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Toselli
authors.affiliation: Department of Cardiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Casadei
authors.affiliation: Department of Radiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Cannizzaro
authors.affiliation: Department of Cardiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Fragale
authors.affiliation: Department of Cardiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fucili
authors.affiliation: Department of Cardiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Campagnolo
authors.affiliation: Department of Radiology, University of Ferrara, S. Anna Hospital, Cona-Ferrara, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Benea
authors.affiliation: Department of Cardiology and LTTA Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferrari
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006333:Heart Failure / Q000628:therapy*; D006352:Heart Ventricles; D065386:Historically Controlled Study; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*
keywords: Cardiac resynchronization therapy; Heart failure; Left ventricular lead position