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Characterization of non‐response to cardiac resynchronization therapy by post‐procedural computed tomography
Author(s) -
Pezel Théo,
Mika Delphine,
Logeart Damien,
CohenSolal Alain,
Beauvais Florence,
Henry Patrick,
Laissy Jean Pierre,
Moubarak Ghassan
Publication year - 2021
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.14134
Subject(s) - medicine , cardiac resynchronization therapy , cardiology , subtraction , lead (geology) , radiology , nuclear medicine , heart failure , ejection fraction , arithmetic , mathematics , geomorphology , geology
Causes of non‐response to cardiac resynchronization therapy (CRT) include mechanical dyssynchrony, myocardial scar, and suboptimal left ventricular (LV) lead location. We aimed to assess the utility of Late Iodine Enhancement Computed Tomography (LIE‐CT) with image subtraction in characterizing CRT non‐response. Methods CRT response was defined as a decrease in LV end‐systolic volume > 15% at 6 months. LIE‐CT was performed after 6 months, and analyzed global and segmental dyssynchrony, myocardial scar, coronary venous anatomy, and position of LV lead relative to scar and segment of latest mechanical contraction. Results We evaluated 29 patients (age 71 ± 12 years; 72% men) including 18 (62%) responders. All metrics evaluating residual dyssynchrony such as wall motion index and wall thickness index were worse in non‐responders. There was no difference in presence and extent of scar between responders and non‐responders. However, in non‐responders, the LV lead was more often over an akinetic/dyskinetic area (72% vs. 22%, p = .007), a fibrotic area (64% vs. 8%, p = .0007), an area with myocardial thickness < 6 mm (82% vs. 22%, p = .002), and less often concordant with the region of maximal wall thickness (9% vs. 72%, p = .001). Among the 11 non‐responders, eight had at least another coronary venous branch visualized by CT, including three (27%) coursing over a potentially interesting myocardial area (free of scar, with normal wall motion, and with a myocardial thickness ≥6 mm). Conclusion LIE‐CT with image subtraction allows a comprehensive characterization of patients after CRT and may provide clues for management of non‐responders.