Advertisement

Analysis of Cardiac MRI Based Regional Timing of Left Ventricular Mechanical Contraction as a Biomarker for Electrical Dyssynchrony in Heart-Failure Patients

  • Prahlad G. Menon
  • Srilakshmi M. Adhyapak
  • V. Rao Parachuri
Conference paper
Part of the Lecture Notes in Computer Science book series (LNCS, volume 8641)

Abstract

Cardiac resynchronization therapy (CRT) is relatively new treatment for symptoms associated with congestive heart failure (HF) which is achieved by simultaneously pacing both the left and right ventricles of the heart. Current clinical guidelines support the use of CRT in moderate or severe HF patients with a left ventricular (LV) ejection fraction of ≤35% and a prolonged QRS interval (≥120 ms), characteristic of electrical dyssynchrony. Several clinical studies have reported high non-response rates to CRT and have questioned the accuracy of currently practiced patient-selection criteria for this therapy. In this study we demonstrate the translational application of medical imaging biomarkers of phase of ventricular contraction quantified from cardiac magnetic resonance (CMR) imaging, in defining correlations between mechanical dysynchrony (MD) and electrical dyssynchrony, in an effort to identify a means to relate the best-practices for positioning an LV pacing lead (viz. localized to the latest mechanically activating, non-scarred regions) with the clinical guidelines for electrical dyssynchrony in a cohort of heart failure (HF). We retrospectively examine two cohorts of HF patients with different electrical conduction characteristics: a) Left bundle branch block (LBBB) and wide QRS interval – defining the Class I indication for CRT – characteristic of electrical dyssynchrony as evidenced from electrocardiograms; and b) HF with large antero-apical aneurysms and scarring but narrow QRS interval. Indices of mean and standard deviation in phase of regional contraction were examined across the entire LV of each patient, including scarred territories. Additionally, contraction timing delay between the septal and lateral cardiac walls were also examined in the basal LV territories which were free from adverse remodelling and scar. The results from this pilot study show that MD assessment using CMR imaging based biomarkers of phase of LV contraction is highly accurate in predicting electrical dyssynchrony defined by QRS duration ≥150 ms, with receiver operator characteristics evidencing close to perfect accuracy when MD was analyzed in LV territories which excluded scar.

Keywords

Cardiac Resynchronization Therapy Cardiac Magnetic Resonance Imaging Heart Failure Fourier Analysis Left Ventricular Contraction 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Abraham, W.T., Fisher, W.G., Smith, A.L., et al.: Cardiac resynchronization in chronic heart failure. N. Engl. J. Med. 346(24), 1845–1853 (1845)CrossRefGoogle Scholar
  2. 2.
    Cazeau, S., Leclercq, C., Lavergne, T., et al.: Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N. Engl. J. Med. 344(12), 873–880 (2001)CrossRefGoogle Scholar
  3. 3.
    Strickberger, S.A., Conti, J., Daoud, E.G., et al.: Patient selection for cardiac resynchronization therapy: from the Council on Clinical Cardiology Subcommittee on Electrocardiography and Arrhythmias and the Quality of Care and Outcomes Research Interdisciplinary Working Group, in collaboration with the Heart Rhythm Society. Circulation 111, 2146–2150 (2005)CrossRefGoogle Scholar
  4. 4.
    Beshai, J.F., Grimm, R.A., Nagueh, S.F., et al.: Cardiac-resynchronization therapy in heart failure with narrow QRS complexes. N. Engl. J. Med. 357(24), 2461–2471 (2007)CrossRefGoogle Scholar
  5. 5.
    Bax, J.J., Gorcsan, J.: 3rd, Echocardiography and noninvasive imaging in cardiac resynchronization therapy: results of the PROSPECT (Predictors of Response to Cardiac Resynchronization Therapy) study in perspective. J. Am. Coll. Cardiol. 53(21), 1933–1943 (2009)CrossRefGoogle Scholar
  6. 6.
    Young, J.B., Abraham, W.T., Smith, A.L., et al.: Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial. Jama 289(20), 2685–2694 (2003)CrossRefGoogle Scholar
  7. 7.
    Leclercq, C., Kass, D.A.: Retiming the failing heart: principles and current clinical status of cardiac resynchronization. J. Am. Coll. Cardiol. 39(2), 194–201 (2002)CrossRefGoogle Scholar
  8. 8.
    Chung, E.S., Leon, A.R., Tavazzi, L., et al.: Results of the Predictors of Response to CRT (PROSPECT) trial. Circulation, 2008 117(20), 2608–2616 (2008)Google Scholar
  9. 9.
    Boogers, M.J., Chen, J., van Bommel, R.J., et al.: Optimal left ventricular lead position assessed with phase analysis on gated myocardial perfusion SPECT. Eur. J. Nucl. Med. Mol Imaging 38(2), 230–238 (2011)CrossRefGoogle Scholar
  10. 10.
    Delgado, V., van Bommel, R.J., Bertini, M., et al.: Relative merits of left ventricular dyssynchrony, left ventricular lead position, and myocardial scar to predict long-term survival of ischemic heart failure patients undergoing cardiac resynchronization therapy. Circulation 123(1), 70–78 (2011)CrossRefGoogle Scholar
  11. 11.
    Ypenburg, C., van Bommel, R.J., Delgado, V., et al.: Optimal Left Ventricular Lead Position Predicts Reverse Remodeling and Survival After Cardiac Resynchronization Therapy. J. Am. Coll. Cardiol. 52(17), 1402–1409 (2008)CrossRefGoogle Scholar
  12. 12.
    Khan, F.Z., Virdee, M.S., Palmer, C.R., et al.: Targeted Left Ventricular Lead Placement to Guide Cardiac Resynchronization Therapy: The TARGET Study: A Randomized, Controlled Trial. J. Am. Coll. Cardiol. 12, j.jacc.2011.12.030 (2011)Google Scholar
  13. 13.
    Heiberg, E., Sjogren, J., Ugander, M., et al.: Design and validation of Segment–freely available software for cardiovascular image analysis. BMC Med. Imaging 10(1), 1 (2010)CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Prahlad G. Menon
    • 1
    • 2
    • 3
  • Srilakshmi M. Adhyapak
    • 4
  • V. Rao Parachuri
    • 5
  1. 1.Joint Institute of Engineering, Sun Yat-sen UniversitySun Yat-sen University - Carnegie Mellon University (SYSU-CMU)China
  2. 2.SYSU-CMU, Shunde International Joint Research InstituteChina
  3. 3.QuantMD, LLCPittsburghUSA
  4. 4.St. John’s Medical College HospitalBangaloreIndia
  5. 5.Narayana Hrudayalaya Institute of Medical SciencesBangaloreIndia

Personalised recommendations