Abstract
Patients with heart failure, reduced ejection fraction, and signs of myocardial dyssynchrony have a poor prognosis. Cardiac resynchronization therapy is a proven therapeutic modality that reduces symptoms of heart failure as well as morbidity and mortality in these patients. Better identification of patients who could benefit from cardiac resynchronization therapy is an important factor because a significant percentage of patients do not experience clinical improvement after CRT implantation. Cardiac magnetic resonance is a useful, non-invasive, sophisticated diagnostic tool that can provide useful information on the aetiology of heart failure and the severity of mechanical dyssynchrony of the left ventricle. It helps evaluate the myocardial scar burden, which can predict a possible unsatisfactory response to therapy and helps improve clinical outcomes by enabling optimal positioning of the LV lead. Cardiac magnetic resonance in patient follow up after CRT implantation is proven to have significant clinical value. Conclusion: Cardiac magnetic resonance is a non-invasive imaging modality that can provide better identification of the patients who could respond well to cardiac resynchronization therapy. By providing valuable information about the severity of mechanical dyssynchrony, the myocardial scar burden and optimal positioning of the LV lead, it is useful in improving clinical outcomes after CRT implantation.
Highlights
Heart failure approximately affects 1-2% of the population in developed countries, with absolute numbers of 15 out of 900 million affected people in Europe and 5.7 out of 300 million in the United States [1]
Current guidelines for the treatment of heart failure recommend cardiac resynchronization therapy in symptomatic patients with heart failure, in sinus rhythm, with ejection fraction less than or equal to 35%, QRS duration more than 150ms and left bundle branch QRS morphology despite optimal medical therapy
It is recommended in patients with heart failure, with ejection fraction less than or equal to 35% and with an indication for venticular pacing and high degree AV block
Summary
Heart failure approximately affects 1-2% of the population in developed countries, with absolute numbers of 15 out of 900 million affected people in Europe and 5.7 out of 300 million in the United States [1]. Current guidelines for the treatment of heart failure recommend cardiac resynchronization therapy in symptomatic patients with heart failure, in sinus rhythm, with ejection fraction less than or equal to 35%, QRS duration more than 150ms and left bundle branch QRS morphology despite optimal medical therapy. Cardiac magnetic resonance is a useful, noninvasive, sophisticated diagnostic tool that can be used in the evaluation of cardiac volumes and function, the etiology of heart failure through specific tissues characterization and in the estimation of severity of the mechanical dyssynchrony [5, 6] It can help provide optimal LV lead positioning and identify the myocardial scar burden, which does improve outcomes [7]. According to the available data, the number of cardiac MRI scans for the last decade in United Kingdom is growing for about 15-20% per year, mainly for the evaluation of heart failure etiology and structural heart diseases [8]
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