Clinical InvestigationCongestive Heart FailureScar burden by myocardial perfusion imaging predicts echocardiographic response to cardiac resynchronization therapy in ischemic cardiomyopathy
Section snippets
Patient population
A database of all patients implanted with CRT-defibrillators (CRT-Ds) at the University of Pittsburgh Medical Center between 2000 and 2005 was searched for those patients who had undergone MPI. Patients with an ICM, defined as systolic dysfunction caused at least in part by angiographically proven coronary artery disease (≥70% stenosis in at least one major epicardial coronary artery), were selected for analysis.
All patients met the following standard criteria for CRT: (1) left ventricular
Patient population
Seventy-eight patients who received a CRT-D device at the University of Pittsburgh Medical Center between 2000 and 2005 also underwent MPI as a part of their clinical care for HF. Twenty-eight of these patients were excluded because of a lack of adequate echocardiographic follow-up (Figure 2). Of the 50 patients included in the present analysis, 28 (56%) had a significant echocardiographic response. Table I illustrates the clinical characteristics of these patients, along with outcome data. Of
Discussion
In this cohort of patients with ICM who underwent CRT-D implantation, we observed an echocardiographic response rate of nearly 60%, which is consistent with published data. Our echocardiographic results demonstrate that there is a negative impact upon CRT response rates as the proportion of overall scar rises and as dense scar becomes more anatomically extensive. In addition, there are diminished returns in those patients in whom the LV lead is implanted in a location with heavy scar burden.
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