Cardiac Magnetic Resonance Identifies Responders to Cardiac Resynchronization Therapy with an Assessment of Septal Scar and Left Ventricular Dyssynchrony

Figures

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  Figure 1. Schematic illustration of septal flash with cine 4-chamber images. The two images per patient are sequential phases of the 4-chamber cine-CMR images. The yellow longitudinal line is in a similar position and has the same length in both images from each patient. The short, transverse blue line marks the endocardial contour of the septum. Patient A displays an early contractile motion of the interventricular septum (septal flash) indicated by the red arrow, with no apparent motion of the lateral wall during the iso-volumic contraction phase (second image). Patient B demonstrates no pre-ejection septal movement (no septal flash). The pink color in the schematic electrocardiogram at the bottom of the figure shows the timing of events in the cardiac cycle.

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  Figure 2. Response rates to CRT stratified to increasing amounts of septal LGE. An increasing amount of septal LGE resulted in decreasing response rates to CRT. Even minor septal LGE significantly reduced the likelihood of response compared with no septal LGE. LGE = late gadolinium enhancement; CRT = cardiac resynchronization therapy. * Denotes statistically significant differences (p < 0.05) between groups.

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  Figure 3. Receiver operator characteristic curve for predicting CRT response with the combined approach of percentage septal LGE and septal flash. (a) All available patients (n = 127). (b) The subgroup of patients with intermediate QRS duration (n = 29). Each point on the ROC curves represents a sensitivity/specificity pair corresponding toa particular decision threshold. CRT = cardiac resynchronization therapy; LGE = late gadolinium enhancement; AUC = area under the curve; CI = confidence interval.

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  Figure 4. Patients without septal LGE and/or with septal flash have significantly better long-term survival as compared with patients with septal LGE and no septal flash. Kaplan–Meier curve stratified according to whether patients had (1) no septal LGE and/or with septal flash (green) or (2) septal LGE and no septal flash (red). * Denotes statistically significant (p < 0.05) differences between the groups. LGE = late gadolinium enhancement; SF = septal flash.