TY - JOUR T1 - Scar burden is an independent and incremental predictor of cardiac resynchronisation therapy response JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2019-001067 VL - 6 IS - 2 SP - e001067 AU - Serge C Harb AU - Saleem Toro AU - Jennifer A Bullen AU - Nancy A Obuchowski AU - Bo Xu AU - Kevin M Trulock AU - Niraj Varma AU - John Rickard AU - Richard Grimm AU - Brian Griffin AU - Scott D Flamm AU - Deborah H Kwon Y1 - 2019/07/01 UR - http://openheart.bmj.com/content/6/2/e001067.abstract N2 - 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. ER -