title: Left ventricular scar impact on left ventricular synchronization parameters and outcomes of cardiac resynchronization therapy.
abstract: BACKGROUND
  Left ventricular scar, including global scar and lateral wall, plays an important role in predicting response to cardiac resynchronization therapy (CRT).
  
  
  METHODS
  Thirty patients underwent CRT implantation. Assessment of left ventricular (LV) dyssynchrony was done through Gated SPECT LV phase analysis. Pre-implantation cardiac magnetic resonance (CMR) with late gadolinium enhancement technique to examine LV scar burden. Echocardiographic examination of LV end-systolic volume (LVES) prior to CRT and 6 months later.
  
  
  RESULTS
  Thirty patients received CRT (mean age 58.7±9.0, 24 males). Reverse LV remodeling (decline ≥15% from baseline VES) was documented in 19 patients. Temporal changes in LV dyssynchrony parameters were correlated to LV reverse remodeling. Applying ROC for predicting CRT non-response showed a cutoff 36.5% of global LV scar burden had a sensitivity of 81.8% and specificity of 68.4%. A cutoff for lateral wall scar burden 40.5% of whole lateral wall had a sensitivity of 72.7% and specificity of 68.4%.
  
  
  CONCLUSIONS
  Reverse LV remodeling is associated with temporal improvements in LV dyssynchrony parameters. LV scar had an unfavorable impact on CRT response. Both global and lateral wall scar burden could predict CRT nonresponse status.
authors: Critical Care Medicine Department, Cairo University, Egypt. Electronic address: walidkimowmmk@gmail.com.
authors: Walid
authors: W
authors: Ahmed
authors: Critical Care Medicine Department, Cairo University, Egypt. Electronic address: waelsamyicu@yahoo.com.
authors: Wael
authors: W
authors: Samy
authors: Critical Care Medicine Department, Cairo University, Egypt. Electronic address: osama_tayeh@hotmail.com.
authors: Osama
authors: O
authors: Tayeh
authors: Radiology Department, Cairo University, Egypt. Electronic address: nohabehairy@gmail.com.
authors: Noha
authors: N
authors: Behairy
authors: Critical Care Medicine Department, Cairo University, Egypt. Electronic address: dr.aliafattah@gmail.com.
authors: Alia
authors: A
authors: Abd El Fattah
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D002921:Cicatrix / Q000000981:diagnostic imaging*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D020257:Ventricular Remodeling
keywords: Cardiac magnetic resonance; Cardiac resynchronization therapy; Lateral wall pacing; Left ventricular dyssynchrony; Left ventricular scar; Phase analysis Gated SPECT