Prediction of Cardiac Resynchronization Therapy Response in Dilated Cardiomyopathy Using Vortex Flow Mapping on Cine Magnetic Resonance Imaging

Figures

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  Figure 1.. A man in his 40 s with dilated cardiomyopathy was classified as a responder 8 months after cardiac resynchronization therapy implantation. (Upper row) Four-chamber cine imaging throughout a cardiac cycle (Left, early-systole; Center, end-systole; Right, end-diastole); (Lower row) vortex flow map at the same phase. Cine imaging shows multiple dark flow phenomena in the dilated left ventricle. (Middle row) Moving dark flow phenomena along the septal wall corresponding to a large vortex with hot colors.

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  Figure 2.. Vortex flow (VF) map and time curves of VF on the (Left) short-axis (SA), (Center) 4-chamber and (Right) long-axis (LA) images. Time curves of the VF were divided into 4 sections. Purple line, VF of septum (SA and 4-chamber) or basal (LA) segment. Red line, VF of the anterior (SA and LA) or apex (4-chamber) segment. Green line, VF of the lateral (SA and 4-chamber) or apex (LA) segment. Blue line VF of the inferior (SA and LA) or basal (4-chamber) segment. Arrow, maximum VF (MVF). (A) A man in his 30 s with dilated cardiomyopathy (DCM) who was a cardiac resynchronization therapy (CRT) responder. He spent 6.6 years without hospitalization for heart failure (HF) after CRT implantation. His summed MVF and left ventricle ejection fraction (LVEF) were 64.7% and 9.8%, respectively. Electrocardiogram (ECG) showed sinus rhythm, complete right bundle branch block (CRBBB), and QRS duration of 160 ms at the same time. (B) A man in his 60 s with DCM who was a CRT non-responder. He was hospitalized due to acute decompensated HF 5 months after CRT implantation. His summed MVF and LVEF were 7.6% and 18.5%, respectively. ECG showed sinus rhythm, intraventricular conduction disturbance, and QRS…

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  Figure 3.. Feature tracking of cardiac magnetic resonance imaging (CMR-FT). Left ventricular (LV) (Upper row) short-axis and (Lower row) 4-chamber cine images ere used for analysis of LV dyssynchrony. CMR-FT semi-automatically tracks the contours of the endocardium and epicardium throughout a cardiac cycle. The LV was divided into 6 segments. The times to peak strain for the septal and lateral walls were obtained from (Right side) time curves of circumferential and longitudinal strain.

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  Figure 4.. Summed maximum vortex flow (MVF) in cardiac resynchronization therapy (CRT) responders vs. non-responders (P<0.05). Horizontal line, maximum and minimum; ends of box, median; whiskers, upper quartile and lower quartile.

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  Figure 5.. Cardiac death and acute decompensated heart failure hospitalization event-free curves after cardiac resynchronization therapy (CRT) according to summed maximum vortex flow (MVF) ≥31.3% (blue) or <31.3% (red) (P=0.034).