Identifying Patients for Cardiac Resynchronization Therapy Beyond Current Guidelines: Insights from Cardiac MRI

Motivation: Nearly 30% of patients undergoing cardiac resynchronization therapy (CRT) according to Class I recommendations do not benefit, highlighting the need for improved patient selection methods. Goal(s): This study aims to enhance risk stratification for CRT candidates with reduced ejection fraction and prolonged QRS by incorporating cardiac magnetic resonance (CMR) imaging factors beyond existing guidelines. Approach: We retrospectively analyzed 711 patients who underwent CMR imaging. The primary endpoint was a composite of cardiac-related events. Results: After a median follow-up of 4.8 years, late gadolinium enhancement (LGE) and left ventricular (LV) strains emerged as independent survival predictors, particularly influencing selection in Class IIa patients. Impact: These findings suggest that integrating CMR imaging into clinical practice can significantly improve candidate selection for CRT, potentially increasing treatment efficacy.