Author + information
- Jack Rickard,
- Ahmad Masri,
- David Spragg,
- Patrick Tchou,
- Richard Grimm,
- Peyman Naji,
- Bruce Wilkoff and
- Milind Desai
In cardiac resynchronization therapy (CRT) patients, sub-optimal lead position & LV scar are thought to predict non-response. Prior studies assessing lead position & scar have had many limitations. Using a multi-modality imaging approach, we sought to determine the role of LV lead position & scar on CRT response.
We studied 80 CRT patients (age 65±12 years, 60% men) who underwent pre/post-CRT transthoracic echoes, positron emission tomography (PET), & chest multidetector computed tomography (MDCT, following CRT, for a clinical reason). CRT response was defined as an absolute reduction in LV end-systolic volume ≥15% on echo. Presence of scar was ascertained on PET. On MDCT, LV lead position was categorized as apical, mid, or basal based on the LV lead position/LV length ratio (distance of LV lead from mitral valve/the mitral valve to apex). LV lead position was also categorized as anterior, lateral, or posterior.
42 (53%) patients were CRT responders. Apical lead position was more frequent in non-responders vs. responders (38% vs. 2%, p<0.001). No difference existed between anterior, lateral, & posterior lead positions.38% had inferolateral scar. Logistic regression testing the association between CRT response & predictors is shown in Figure 1. 12 patients had both an apical lead & inferolateral scar all belonging to the non-response group.
In patients undergoing CRT, apical lead position & inferolateral scar are associated with non-response.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Multimodality Imaging in Cardiomyopathy
Abstract Category: 20. Imaging: CT/Multimodality
Presentation Number: 1316-368
- 2013 American College of Cardiology Foundation