Combined identification of septal flash and absence of myocardial scar by cardiac magnetic resonance imaging improves prediction of response to cardiac resynchronization therapy

Manav Sohal, Sana Amraoui, Zhong Chen, Eva Sammut, Tom Jackson, Matthew Wright, Mark O'Neill, Jaswinder Gill, Gerald Carr-White, C Aldo Rinaldi, Reza Razavi

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

BACKGROUND AND AIMS OF STUDY: Septal flash (SF) describes early inward motion of the ventricular septum in patients with left bundle branch block (LBBB), and correction corresponds to increased response to cardiac resynchronization therapy (CRT). SF has traditionally been assessed by echocardiography. We sought to determine if cardiac magnetic resonance (CMR) imaging could identify SF and if the additional assessment of scar would improve the ability of CMR to predict CRT response.

METHODS: Fifty-two patients with LBBB and heart failure underwent prospective CMR scanning prior to CRT implantation. The presence of SF was assessed visually and by using endocardial contour-tracking software. Presence and extent of myocardial scar was assessed by delayed enhancement imaging during CMR. The association between SF, scar and reverse remodelling (RR) at 6 months was explored.

RESULTS: RR rate to CRT at 6 months was 52%. CMR-derived SF was identified in 24 (46%) patients. RR was seen in more patients with SF than those without (88% vs 21%; P < 0.001). The absence of scar combined with the presence of SF had 96% specificity for predicting RR. In a multivariate regression model, the presence of SF was the only independent predictor of RR.

CONCLUSION: SF can be assessed by CMR and predicts increased response to CRT. The additional value of CMR is the assessment of scar. The presence of SF with no scar is a highly specific predictor of CRT response.

Original languageEnglish
Pages (from-to)179-90
Number of pages12
JournalJournal of Interventional Cardiac Electrophysiology
Volume40
Issue number2
DOIs
Publication statusPublished - Aug 2014

Keywords

  • Bundle-Branch Block/mortality
  • Cardiac Resynchronization Therapy/mortality
  • Cicatrix/mortality
  • Comorbidity
  • Female
  • Heart Septum/pathology
  • Humans
  • Magnetic Resonance Imaging, Cine/statistics & numerical data
  • Male
  • Middle Aged
  • Outcome Assessment (Health Care)/methods
  • Prevalence
  • Prognosis
  • Reproducibility of Results
  • Risk Factors
  • Sensitivity and Specificity
  • Survival Rate
  • Treatment Outcome
  • United Kingdom/epidemiology

Fingerprint Dive into the research topics of 'Combined identification of septal flash and absence of myocardial scar by cardiac magnetic resonance imaging improves prediction of response to cardiac resynchronization therapy'. Together they form a unique fingerprint.

Cite this