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Background Cardiac resynchronization therapy (CRT) benefits selected heart failure patients; however, CRT has a nonresponse rate of approximately 30-40%. Important factors that contribute to lead placement decisions and overall CRT success include determination of mechanical dyssynchrony, presence and location of scar, and the identification of late-activated segments. Recent imaging studies have reported progress in the first two areas. Previously, myocardial tagging showed promise for mapping mechanical activation time [1], but analysis of tagged images is time consuming. We investigated the use of cine DENSE to detect regions of late mechanical activation. Methods Cine DENSE at a temporal resolution of 17 ms, in-plane pixel size of 1.4 mm × 1.4 mm to 2.2 mm × 2.2 mm, and slice thickness of 8 mm was performed in standard short-axis planes in 4 canines with pacing-induced heart failure and left bundle branch block (LBBB) induced by catheter ablation. Using semi-automatic analysis methods [2,3], regional circumferential strain (Ecc) was determined from the mid-cavity short-axis DENSE images. The time to the onset of contraction (mechanical activation time) was defined as the time at which the slope of each Ecc curve first became negative, as shown in Figure 1. The mechanical activation time was computed for regions that were 5 × 5 pixels in size. Results Cine DENSE showed that the septum underwent early activation, while the late-activated regions were consistently located in the anterolateral and inferolateral segments. These patterns were visualized using time-to

journal of cardiovascular magnetic resonance

Cine DENSE MRI detects delayed mechanical activation of the left ventricular free wall in a canine model of heart failure with left bundle branch block