TY - JOUR
T1 - Feasibility of CMR Imaging during Biventricular Pacing
T2 - Comparison with Invasive Measurement as a Pathway towards a Novel Optimization Strategy
AU - Hopman, Luuk H. G. A.
AU - Zweerink, Alwin
AU - van der Lingen, Anne-Lotte C. J.
AU - Huntelaar, Marthe J.
AU - Mulder, Mark J.
AU - Robbers, Lourens F. H. J.
AU - van Rossum, Albert C.
AU - van Halm, Vokko P.
AU - Götte, Marco J. W.
AU - Allaart, Cornelis P.
N1 - Funding Information: This work was supported by BIOTRONIK SE & Co. KG (Berlin, Germany) (grant number FF029). Publisher Copyright: © 2023 by the authors.
PY - 2023/6/1
Y1 - 2023/6/1
N2 - Objectives: This prospective pilot study assessed the feasibility of cardiovascular magnetic resonance (CMR) imaging during biventricular (BIV) pacing in patients with a CMR conditional cardiac resynchronization therapy defibrillator (CRT-D) and compared the results with invasive volume measurements. Methods: Ten CRT-D patients underwent CMR imaging prior to device implantation (baseline) and six weeks after device implantation, including CRT-on and CRT-off modes. Left ventricular (LV) function, volumes, and strain measurements of LV dyssynchrony and dyscoordination were assessed. Invasive pressure–volume measurements were performed, matching the CRT settings used during CMR. Results: Post-implantation imaging enabled reliable cine assessment, but showed artefacts on late gadolinium enhancement images. After six weeks of CRT, significant reverse remodeling was observed, with a 22.7 ± 11% reduction in LV end-systolic volume during intrinsic rhythm (CRT-off). During CRT-on, the LV ejection fraction significantly improved from 27.4 ± 5.9% to 32.2 ± 8.7% (p < 0.01), and the strain assessment showed the abolition of the left bundle branch block contraction pattern. Invasively measured and CMR-assessed LV hemodynamics during BIV pacing were significantly associated. Conclusions: Post-CRT implantation CMR assessing acute LV pump function is feasible and provides important insights into the effects of BIV pacing on cardiac function and contraction patterns. LV assessment during CMR may constitute a future CRT optimization strategy.
AB - Objectives: This prospective pilot study assessed the feasibility of cardiovascular magnetic resonance (CMR) imaging during biventricular (BIV) pacing in patients with a CMR conditional cardiac resynchronization therapy defibrillator (CRT-D) and compared the results with invasive volume measurements. Methods: Ten CRT-D patients underwent CMR imaging prior to device implantation (baseline) and six weeks after device implantation, including CRT-on and CRT-off modes. Left ventricular (LV) function, volumes, and strain measurements of LV dyssynchrony and dyscoordination were assessed. Invasive pressure–volume measurements were performed, matching the CRT settings used during CMR. Results: Post-implantation imaging enabled reliable cine assessment, but showed artefacts on late gadolinium enhancement images. After six weeks of CRT, significant reverse remodeling was observed, with a 22.7 ± 11% reduction in LV end-systolic volume during intrinsic rhythm (CRT-off). During CRT-on, the LV ejection fraction significantly improved from 27.4 ± 5.9% to 32.2 ± 8.7% (p < 0.01), and the strain assessment showed the abolition of the left bundle branch block contraction pattern. Invasively measured and CMR-assessed LV hemodynamics during BIV pacing were significantly associated. Conclusions: Post-CRT implantation CMR assessing acute LV pump function is feasible and provides important insights into the effects of BIV pacing on cardiac function and contraction patterns. LV assessment during CMR may constitute a future CRT optimization strategy.
KW - biventricular pacing
KW - cardiac resynchronization therapy (CRT)
KW - cardiovascular magnetic resonance (CMR)
KW - dyssynchrony
UR - http://www.scopus.com/inward/record.url?scp=85164013367&partnerID=8YFLogxK
U2 - https://doi.org/10.3390/jcm12123998
DO - https://doi.org/10.3390/jcm12123998
M3 - Article
C2 - 37373691
SN - 0009-9147
VL - 12
JO - Clinical Chemistry
JF - Clinical Chemistry
IS - 12
M1 - 3998
ER -