Key result
Myocardial scar burden under ~23% predicts CRT response with 93% specificity.
Why the study?
Around 30 -45% of heart failure patients are non-responders to CRT, motivating efforts to improve selection criteria beyond standard measures of electrical dyssynchrony. This study assessed the predictive value of the amount and distribution of myocardial fibrosis to identify CRT responders compared to conventional measures.
Does pre-implantation myocardial scar burden quantified by cardiac MRI or nuclear imaging predict echocardiographic reverse remodeling response in heart failure patients undergoing cardiac resynchronization therapy?
Observational (n=58)
Single-blind
No
Does pre-implantation myocardial scar burden quantified by cardiac MRI or nuclear imaging predict echocardiographic reverse remodeling response in heart failure patients undergoing cardiac resynchronization therapy?
Pre-implantation global myocardial scar burden <22.9% on cardiac MRI or nuclear imaging strongly predicts echocardiographic reverse remodeling after CRT, independent of QRS duration or cardiomyopathy etiology.
Objectives: Cardiac resynchronization therapy (CRT) has been shown to improve quality of life and reduce mortality in patients with heart failure.Around 30 -45% are non-responders to CRT.Determinants of response to CRT have been extensively studied.Faithful efforts were exerted to improve selection criteria for CRT beyond standard measures of electrical dyssynchrony.We aimed to assess the predictive value of amount and distribution of myocardial fibrosis to identify responders to CRT compared to conventional measures.Methodology: 58 patients who underwent CRT implantation on the basis of standard indication were studied.All patients had available myocardial imaging (cardiac MRI or nuclear scan) prior to CRT.Images were analyzed for scar quantification and distribution.Multiple variables were studied.Receiver operator characteristic (ROC) curve analysis was used to evaluate the ability of Global scar to predict response to CRT.Results: 30 patients of 58 were non-responders to CRT. 27 patients had non-ischemic cardiomyopathy, while 31 patients had ischemic cardiomyopathy.19 patients (70.3%) in the non-ischemic group, and 9 patients (32.2%) in the ischemic group were responders to CRT, with a statistically significant difference, p-value: 0.002.A cutoff threshold of myocardial scar at 22.9% independently predicted response to CRT with a sensitivity of 70% and a specificity of 92.9%.Conclusion: Global myocardial scar burden predicted response to CRT independent of etiology, regional distribution, and measures of electrical dyssynchrony.
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A 2026 study conducted an observational in Heart failure undergoing cardiac resynchronization therapy (n=58). Global myocardial scar burden vs. CRT responders vs. non-responders (or scar burden cutoff of 22.9%) was evaluated on Echocardiographic reverse remodeling response to CRT (>=15% decrease in LVESV and/or >10% improvement in LVEF) (p=0.001). Global myocardial scar burden at a 22.9% cutoff independently predicted CRT response with 70% sensitivity and 92.9% specificity (AUC 0.856, p=0.001).
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