Details

Autor(en) / Beteiligte

• Bilchick, Kenneth C
• Loffler, Adrian I
• Auger, Daniel
• Fuller, Daniela
• Mason, Pamela K
• Darby, Andrew E
• Malhotra, Rohit
• Ferguson, John
• Mangrum, Michael
• Mehta, Nishaki
• Kramer, Christopher M
• Epstein, Frederick H

Titel

Abstract 12778: Differences in Cardiac Magnetic Resonance Characteristics of Upgrade versus De Novo Cardiac Resynchronization Therapy Implants

Ist Teil von

• Circulation (New York, N.Y.), 2018-11, Vol.138 (Suppl_1 Suppl 1), p.A12778-A12778

Ort / Verlag

by the American College of Cardiology Foundation and the American Heart Association, Inc

Erscheinungsjahr

2018

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• IntroductionPatients undergoing upgrades from a standard pacemaker or implantable cardioverter defibrillator to a cardiac resynchronization therapy pacemaker (CRT-P) or defibrillator (CRT-D) have higher reported complications rates, more vascular access issues, and a higher prevalence of right ventricular (RV) pacing dependence; however, the same selection criteria and implant strategies used for de novo CRT implants are typically applied to upgrade patients.HypothesisCardiac magnetic resonance imaging (CMR) can define key structural differences between upgrade versus de novo CRT patients that have potential utility for patient selection and optimization of implant strategies.MethodsIn 60 patients undergoing CRT, MRIs with gradient echo (GRE) or steady state free precession (SSFP) cine imaging, late gadolinium enhancement (LGE), and Displacement Encoding with Stimulated Echoes (DENSE) were performed. Cine feature tracking (2D CPA MR, TomTec, Inc.) was used to assess regional left ventricular (LV) circumferential strain and dyssynchrony (circumferential uniformity ratio estimate with singular value decomposition [CURE-SVD]).ResultsAmong 60 patients (age 65.0 ± 10.5 years, 17.3% female) undergoing CRT (de novo in 50 patients; upgrade in 10 patients), CRT upgrade patients had decreased left ventricular end-diastolic and end-systolic volume indices relative to de novo CRT patients (LVEDVI 90.6 ± 37.7 versus 127.8 ± 39.9 ml/m; LVESVI 69.5 ± 33.7 versus 102.5 ± 36.3 ml/m; P=0.01 for both), but the LVEF was similar (overall median 0.23; IQR 0.14 to 0.31). While CURE-SVD was not significantly different between groups (overall 0.60 ± 0.22), upgrade patients, particularly those with RV pacing, more frequently had latest mechanical activation in anterior/anterolateral segments (70% versus 20%; P=0.001) (Figure; red=late activation), while inferolateral late activation was more common in de novo patients.ConclusionsCMR shows that patients undergoing CRT upgrades have distinct LV structural findings compared with those undergoing de novo implants, including smaller LV volumes and a greater frequency of latest mechanical activation in anterior/anterolateral segments. This has important implications for LV lead placement.