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European Journal of Echocardiography Advance Access originally published online on September 10, 2007
European Journal of Echocardiography 2008 9(4):483-488; doi:10.1016/j.euje.2007.07.002
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

The influence of myocardial scar and dyssynchrony on reverse remodeling in cardiac resynchronization therapy

Annemieke H.M. Jansen1,*, Frank Bracke1, Jan melle van Dantzig1, Kathinka H. Peels1, Johannes C. Post1, Harrie C.M. van den Bosch2, Berry van Gelder1, Albert Meijer1, Hendrikus H.M. Korsten3, Jolanda de Vries4 and Norbert M. van Hemel5

1 Department of Cardiology, Catharina Hospital, Michelangelolaan 2, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands
2 Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
3 Technical University of Eindhoven, Eindhoven, The Netherlands
4 Department of Psychology and Health, Medical Psychology, Tilburg University, Tilburg, The Netherlands
5 Utrecht University, Utrecht, The Netherlands

Received 18 April 2007; accepted after revision 22 July 2007; online publish-ahead-of-print 10 September 2007.

* Corresponding author. Tel: +31 40 239 7004; fax: +31 40 244 7885. E-mail address: annemieke.jansen{at}cze.nl (A.H.M. Jansen).


  Abstract

Aim: The influence of location and extent of transmural scar and its relation with dyssynchrony in cardiac resynchronization therapy (CRT) was investigated as posterolateral scar tissue has been invoked as a cause of non-response to CRT.

Methods and results: Fifty-seven patients eligible for CRT were assessed for transmural scar with gadolinium-enhanced MRI and for left ventricular (LV) dyssynchrony with tissue Doppler. After implant, both atrioventricular and interventricular pacing intervals were optimized. LV reverse remodeling was defined as ≥10% decrease in LV end-systolic volume after 3 months. Sixteen patients had transmural scar in the posterolateral (PL) area (LV lead location), 14 at a remote site (non-PL) and 27 patients had no scar. LV reverse remodeling was observed in respectively 25%, 64% and 89% (P = 0.0001). Univariate analyses showed a relation with LV dyssynchrony (P = 0.004) and with absence of PL scar (P = 0.04) but not with QRS duration and the extent of LV scar tissue. In multivariate analysis, only LV dyssynchrony (OR: 19.62; 95% CI: 2.5–151.9; P = 0.004) independently predicted LV reverse remodeling.

Conclusion: In this study LV dyssynchrony remains the most important determinant of response to CRT, even in the presence of posterolateral scar provided atrioventricular and interventricular pacing intervals are optimized.

Keywords: Cardiac resynchronization therapy; Heart failure; Magnetic resonance imaging; Echocardiography; Myocardial infarction


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