A combined analysis of large vectorcardiographic QRSarea and small CMR focal scar predicted a 92% cardiac resynchronization therapy response rate.
Observational (n=33)
Does combining vectorcardiographic QRSarea and CMR myocardial scar quantification improve prediction of response to cardiac resynchronization therapy in CRT patients?
Combining vectorcardiographic QRSarea with CMR-derived focal scar quantification provides incremental predictive value for identifying patients likely to respond to cardiac resynchronization therapy.
To investigate the relationship between vectorcardiography (VCG) and myocardial scar on cardiac magnetic resonance (CMR) imaging, and whether combining these metrics may improve cardiac resynchronization therapy (CRT) response prediction. Thirty-three CRT patients were included. QRSarea, Tarea and QRSTarea were derived from the ECG-synthesized VCG. CMR parameters reflecting focal scar core (Scar2SD, Gray2SD) and diffuse fibrosis (pre-T1, extracellular volume ECV) were assessed. CRT response was defined as ≥15% reduction in left ventricular end-systolic volume after six months' follow-up. VCG QRSarea, Tarea and QRSTarea inversely correlated with focal scar (R = −0.44–−0.58 for Scar2SD, p ≤ 0.010), but not with diffuse fibrosis. Scar2SD, Gray2SD and QRSarea predicted CRT response with AUCs of 0.692 (p = 0.063), 0.759 (p = 0.012) and 0.737 (p = 0.022) respectively. A combined ROC-derived threshold for Scar2SD and QRSarea resulted in 92% CRT response rate for patients with large QRSarea and small Scar2SD or Gray2SD. QRSarea is inversely associated with focal scar on CMR. Incremental predictive value for CRT response is achieved by a combined CMR-QRSarea analysis.
Nguyên et al. (Wed,) conducted a observational in Heart failure requiring cardiac resynchronization therapy (n=33). Vectorcardiographic QRSarea and CMR myocardial scar quantification was evaluated on CRT response (≥15% reduction in left ventricular end-systolic volume). A combined analysis of large vectorcardiographic QRSarea and small CMR focal scar predicted a 92% cardiac resynchronization therapy response rate.