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Background Cardiac resynchronization therapy (CRT) is an effective treatment for selected patients with heart failure (HF) and left bundle branch block (LBBB). However, an ongoing major issue with CRT is that 30-50% of treated patients are non-responders. One potential cause of a poor response is implantation of the CRT left-ventricular (LV) pacing lead at a suboptimal location, i.e., a location with scar or where mechanical activation is not delayed [1,2]. This study developed and applied cine DENSE strain imaging [3] to map mechanical activation and detect late-activated segments. Methods Cine DENSE was performed on a 1.5T MRI system in standard short-axis planes in 6 healthy subjects and 16 HF patients with LBBB and nonischemic cardiomyopathy referred to CRT. Circumferential strain (Ecc) was computed using previously described semiautomatic methods [4,5]. Midwall Ecc was arranged into a matrix with 18 rows representing spatial segments of the LV and 30-45 columns representing cardiac phases (Fig 1a). Singular value decomposition (SVD) was applied to denoise the spatiotemporal Ecc matrix, and an active contour method was used to automatically estimate the

Cardiac mechanical activation mapping in heart failure patients with left bundle branch block using cine DENSE MRI