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Left ventricular regional remodeling and lead position during cardiac resynchronization therapy.

Abstract：

BACKGROUND:Cardiac resynchronization therapy (CRT) induces segmental left ventricular (LV) remodeling. The LV lead position (LV-LP) affects response to CRT and remodeling. OBJECTIVE:We aimed to assess segmental remodeling concordant, adjacent, and remote to LV-LP using cardiac computed tomography (CT). METHODS:We included patients from the Empiric Versus Imaging-Guided Left Ventricular Lead Placement in Cardiac Resynchronization Therapy trial. Dynamic cardiac CT was performed at baseline and after 6 months. We assessed systolic wall thickening (WT) and exact LV-LP from the CT scans according to a 16-segment model. Response to CRT was defined as ≥15% reduction in LV end-systolic volume. RESULTS:A total of 107 consecutive patients were included. The change in WT from baseline to follow-up was -19% (95% confidence interval [CI] -25% to -13%; P < .001) in concordant segments, -0.1% (95% CI -5% to 5%; P = .97) in adjacent segments, and 20% (95% CI -17% to 23%; P < .001) in remote segments. Diastolic wall thickness changed only marginally. Twenty patients (19%) were nonresponders at follow-up. In nonresponders with nonischemic cardiomyopathy, we observed a significant reduction in WT in concordant and adjacent segments with no increase in WT in remote segments. CONCLUSION:During CRT, systolic WT increases in segments remote to LV-LP, decreases in concordant segments, and remains unchanged in adjacent segments. Only marginal changes occur in wall thickness. In nonresponders with nonischemic cardiomyopathy, deleterious changes in segmental myocardial function occur, and further studies on how to treat these patients best are warranted.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Kronborg MB,Sommer A,Fyenbo DB,Norgaard BL,Gerdes C,Jensen JM,Jensen HK,Kristensen J,Nielsen JC

doi

10.1016/j.hrthm.2018.04.012

subject

Has Abstract

pub_date

2018-10-01 00:00:00

pages

1542-1549

issue

10

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(18)30355-2

journal_volume

15

pub_type

杂志文章,随机对照试验

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