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Heart failure and cardiomyopathies
Original research article
Scar burden is an independent and incremental predictor of cardiac resynchronisation therapy response
  1. Serge C Harb1,
  2. Saleem Toro1,
  3. Jennifer A Bullen2,
  4. Nancy A Obuchowski2,
  5. Bo Xu1,
  6. Kevin M Trulock1,
  7. Niraj Varma1,
  8. John Rickard1,
  9. Richard Grimm1,
  10. Brian Griffin,
  11. Scott D Flamm1 and
  12. Deborah H Kwon1
  1. 1Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Deborah H Kwon; kwond{at}ccf.org

Abstract

Objective Determine the prognostic impact of scar quantification (scar %) by cardiac magnetic resonance (CMR) in predicting heart failure admission, death and left ventricular (LV) function improvement following cardiac resynchronisation therapy (CRT), after controlling for the presence of left bundle branch block (LBBB), QRS duration (QRSd) and LV lead tip location and polarity.

Methods Consecutive patients who underwent CMR between 2002 and 2014 followed by CRT were included. The primary endpoint was death or heart failure admission. The secondary endpoint was change in ejection fraction (EF) ≥3 months after CRT. Cox proportional hazards, linear regression models and change in the area under the receiver operating characteristic curve (AUC) were used.

Results A total of 84 patients were included (63% male, 51% with ischaemic cardiomyopathy). After adjusting for clinical factors, presence of LBBB and QRSd and LV lead tip location and polarity, greater scar % remained associated with a higher risk for clinical events (HR=1.06; 95% CI 1.02 to 1.10; p<0.001) and a smaller improvement in EF (slope: −0.61%; 95% CI −0.93% to 0.29%; p<0.001). When adding scar % to QRSd and LBBB, there was significant improvement in predicting clinical events at 3 years (AUC increased to 0.831 from 0.638; p=0.027) and EF increase ≥10% (AUC 0.869 from 0.662; p=0.007).

Conclusion Scar quantification by CMR has an incremental value in predicting response to CRT, in terms of heart failure admission, death and EF improvement, independent of the presence of LBBB, QRSd, LV lead tip location and polarity.

  • cardiac MRI
  • cardiac resynchronisation therapy response
  • incremental value

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/openhrt-2019-001067

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    Footnotes

    • Contributors All of the authors contributed significantly in patient referral, study design, data analysis, as well as the manuscript preparation. All the authors have read and have approved the manuscript in its current form.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. The authors would like to acknowledge the Dellovade Fund for providing the funding to cover the publication cost of publishing this manuscript.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The Institutional Review Board approved the study and informed consent was waived.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.