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Longitudinal ventricular function to determine the effect of cardiac resynchronization therapy in patients with heart failure

Session Poster session 1

Speaker Bjoern Oestenson

Congress : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Systolic and Diastolic Function
  • Session type : Poster Session
  • FP Number : P156

Authors : B Oestenson (Lund,SE), E Ostenfeld (Lund,SE), Z Bakos (Lund,SE), M Kanski (Lund,SE), E Heiberg (Lund,SE), H Arheden (Lund,SE), R Borgquist (Lund,SE), M Carlsson (Lund,SE)

Authors:
B Oestenson1 , E Ostenfeld1 , Z Bakos2 , M Kanski1 , E Heiberg1 , H Arheden1 , R Borgquist2 , M Carlsson1 , 1Skane University Hospital, Department of Clinical Physiology and Nuclear Medicine - Lund - Sweden , 2Skane University Hospital, Department of Arrhythmia - Lund - Sweden ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii110

Background: Cardiac resynchronization therapy (CRT) restores ventricular synchrony and induce left ventricular (LV) reverse remodeling in heart failure patients with decreased ejection fraction and prolonged QRS-duration. However, an estimated 30% of treated patients are objective non-responders. Cardiac magnetic resonance imaging (CMR) can be used to quantify regional contributions to stroke volume (SV) as potential CRT predictors. Septal contribution to stroke volume has been shown to be lower in patients with heart failure compared to healthy volunteers, with similar longitudinal contribution. These new measures may be influenced by dyssynchrony and hence improve selection of patients for CRT.

Purpose: The aim of this study was to quantify LV longitudinal and septal contribution to SV (SVlong% and SVsept%) and test the hypothesis that these parameters could predict treatment effects in patients undergoing CRT.

Methods: Eighty-one patients (22 women) eligible for CRT were prospectively recruited for CMR. SVlong% and SVsept% (Figure 1) were compared to outcome measures. Outcome was assessed as LV reverse remodeling, defined as reduced LV end-systolic volume (LVESV) measured by echocardiography. CMR measures were compared with 20 age and gender matched healthy controls.

Results: Fifty-four patients completed the study protocol (18 women; 67.8 ± 7.9 [mean ± SD] years). Septal movement in patients contributed -0.5 ± 13.5% to SV vs 9.5 ± 4.4% in controls (p<0.01) and longitudinal AVPD movement 8.2 ± 2.7 mm vs 15.3 ± 1.6 mm in controls (p=0.5). ?LVESV between six months follow-up and baseline was -18.0 ± 20.5%. There were no differences in SVlong% nor SVsept% between responders and non-responders (Table 1).

Conclusion: Quantitative assessment of septal movement showed almost half of the patients eligible for CRT had a septal shift towards the right ventricle during systole. This negative septal contribution to SV was compensated by increased lateral contributions. However, LV reverse remodeling did not relate to pre-operative septal motion to the left or right or to longitudinal contribution to SV.

Parameter

Responders

ΔLVESV ≥15%

Non-responders

ΔLVESV <15%

Healthy controls
LVAVPD (mm) 8.1 ± 2.7 8.4 ± 2.7 15.3 ± 1.6*
SVlong% (%) 66.2 ± 19.7 59.1 ± 11.6 64.4 ± 7.8
SVsept% (%) -2.5 ± 17.1 2.0 ± 11.2 9.5 ± 4.4*
*p<0.05 comparing patients with healthy controls. Values are expressed as means ± SD. ?LVESV, delta left ventricular end-systolic volume; CRT, cardiac resynchronization therapy; LVAVPD, left ventricular atrioventricular plane displacement; SVlong%, longitudinal contribution to SV; SVsept%. septal contribution to stroke volume.

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