Feasibility of CMR Imaging during Biventricular Pacing: Comparison with Invasive Measurement as a Pathway towards a Novel Optimization Strategy

Figures

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  Figure 1. Post-implant CMR image quality. Image quality score in CRT-D patients per segment assessed on short axis images. 1: No image artefact at all, and no limitation in image interpretation. 2: Good image quality, with limited artefacts. 3: Poor image quality, with substantial artefacts. 4: Meaningful image assessment impossible due to extensive artefacts.

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  Figure 2. LV volumes and function assessed by CMR at baseline and during follow-up. Comparison of CMR parameters (A) end systolic volume, (B) end diastolic volume, (C) left ventricular ejection fraction, (D) peakseptal - peaklateral delay, and (E) systolic rebound stretch at baseline and follow-up during biventricular pacing and intrinsic rhythm.

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  Figure 3. LV circumferential strain assessed using CMR at baseline and follow-up. Left ventricular (LV) circumferential strain curves of the lateral (red) and septal (blue) wall at baseline and follow-up during biventricular (BIV) pacing and intrinsic rhythm. Figures explain the assessment of peakseptal - peaklateral circumferential strain delay and systolic rebound stretch. Strain curves of the septal and lateral wall segments display an opposite movement (dotted line) in systole (determined by cine imaging of the LV in the three-chamber view) during follow-up intrinsic rhythm (CRT-off) and at baseline.

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  Figure 4. Relationship between invasively and CMR-measured LV volumes and function. In panel (A,B), a patient example of invasively obtained pressure–volume loops and volume–time curves during BIV pacing and intrinsic rhythm are displayed. Combining the invasively obtained pressures with the MRI volumes, we reconstructed pressure–volume loops and volume–time curves during BIV pacing and intrinsic rhythm (C,D). The invasive measurements are calibrated using the CMR volumes at intrinsic rhythm. Therefore, the correlations between invasively measured (conductance catheter) and non-invasively measured (CMR) indices (ESV (E), EDV (F), stroke volume (G), and LVEF (H)) are shown for BIV pacing.

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  Figure 5. Patient example: CMR cine and LGE images at baseline and follow-up. Image quality display of the two-chamber and mid-short axis cine imaging at baseline (A,B), follow-up using the SSFP technique (C,D), and follow-up using the spoiled gradient echo (GRE) technique (E,F). Image quality display of two-chamber and mid-short axis LGE imaging at baseline (G,H), follow-up using the conventional LGE (I,J), and follow-up using the wideband LGE technique (K,L).