Key result
Combining CMR focal scar and vectorcardiographic QRSarea improves CRT response prediction to an AUC of ~0.74.
Why the study?
Does combining vectorcardiographic QRSarea and CMR focal scar quantification improve the prediction of CRT response in heart failure patients?
Observational (n=33)
No
Does combining vectorcardiographic QRSarea and CMR focal scar quantification improve the prediction of CRT response in heart failure patients?
Answers are grounded in this paper and cite their sources.
Combining 12-lead ECG-synthesized QRSarea with CMR focal scar quantification can significantly improve the selection of candidates for 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.
No takes yet. Share an insight, caveat, or question.
Nguyên et al. (2018) conducted an observational in Heart failure requiring cardiac resynchronization therapy (n=33). Vectorcardiographic QRSarea and CMR focal scar quantification was evaluated on Cardiac resynchronization therapy response (≥15% reduction in left ventricular end-systolic volume) (AUC 0.737, p=0.022). Combined analysis of cardiac magnetic resonance-defined focal scar and vectorcardiographic QRSarea improved the prediction of CRT response.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: