Abstract：
BACKGROUND: Left ventricular lead positioning represents a key step in CRT optimization. However, evidence for its guidance based on specific topographical factors and related imaging techniques is sparse.
OBJECTIVE: To analyze reverse remodeling (RR) and clinical events in CRT recipients based on LV cathode (LVC) position relative to latest mechanical activation (LMA) and scar as determined by cardiac magnetic resonance (CMR).
METHODS: This is a retrospective single-center study of 68 consecutive Q-LV-guided CRT-D and CRT-P recipients. Through CMR-based 3D reconstructions overlayed on fluoroscopy images, LVCs were stratified as concordant, adjacent, or discordant to LMA (3 segments with latest and greatest radial strain) and scar (segments with >50% scar transmurality). The primary endpoint of RR (expressed as percentage ESV change) and secondary composite endpoint of HF hospitalizations, LVAD/heart transplant, or cardiovascular death were compared across categories.
RESULTS: LVC proximity to LMA was associated with a progressive increase in RR (percentage ESV change: concordant -47.0 ± 5.9%, adjacent -31.4 ± 3.1%, discordant +0.4 ± 3.7%), while proximity to scar was associated with sharply decreasing RR (concordant +10.7 ± 12.9%, adjacent +0.3 ± 5.3%, discordant -31.3 ± 4.4%, no scar -35.4 ± 4.8%). 4 integrated classes of LVC position demonstrated a significant positive RR gradient the more optimal the category (class I -47.0 ± 5.9%, class II -34.9 ± 2.8%, class III -5.5 ± 4.3%, class IV + 3.4 ± 5.2%). Freedom from composite secondary endpoint of HF hospitalization, LVAD/heart transplant, or cardiovascular death confirmed these trends demonstrating significant differences across both integrated as well as individual LMA and scar categories.
CONCLUSIONS: Integrated CMR-determined LVC position relative to LMA and scar stratifies response to CRT.
OBJECTIVE: To analyze reverse remodeling (RR) and clinical events in CRT recipients based on LV cathode (LVC) position relative to latest mechanical activation (LMA) and scar as determined by cardiac magnetic resonance (CMR).
METHODS: This is a retrospective single-center study of 68 consecutive Q-LV-guided CRT-D and CRT-P recipients. Through CMR-based 3D reconstructions overlayed on fluoroscopy images, LVCs were stratified as concordant, adjacent, or discordant to LMA (3 segments with latest and greatest radial strain) and scar (segments with >50% scar transmurality). The primary endpoint of RR (expressed as percentage ESV change) and secondary composite endpoint of HF hospitalizations, LVAD/heart transplant, or cardiovascular death were compared across categories.
RESULTS: LVC proximity to LMA was associated with a progressive increase in RR (percentage ESV change: concordant -47.0 ± 5.9%, adjacent -31.4 ± 3.1%, discordant +0.4 ± 3.7%), while proximity to scar was associated with sharply decreasing RR (concordant +10.7 ± 12.9%, adjacent +0.3 ± 5.3%, discordant -31.3 ± 4.4%, no scar -35.4 ± 4.8%). 4 integrated classes of LVC position demonstrated a significant positive RR gradient the more optimal the category (class I -47.0 ± 5.9%, class II -34.9 ± 2.8%, class III -5.5 ± 4.3%, class IV + 3.4 ± 5.2%). Freedom from composite secondary endpoint of HF hospitalization, LVAD/heart transplant, or cardiovascular death confirmed these trends demonstrating significant differences across both integrated as well as individual LMA and scar categories.
CONCLUSIONS: Integrated CMR-determined LVC position relative to LMA and scar stratifies response to CRT.
摘要：
背景：左心室导线定位是CRT优化的关键步骤。然而,基于特定地形因素和相关成像技术的指导证据很少。
目的：根据心脏磁共振（CMR）测定的左心室阴极（LVC）相对于最新机械激活（LMA）和瘢痕的位置，分析CRT患者的逆重构（RR）和临床事件。
方法：这是一项对68名连续Q-LV引导的CRT-D和CRT-P受者的回顾性单中心研究。通过基于CMR的3D重建叠加在荧光图像上，LVC被分层为一致的，相邻,或与LMA（具有最新和最大的径向应变的3个节段）和疤痕（具有>50％疤痕透壁性的节段）不一致。RR的主要终点（以ESV变化百分比表示）和HF住院的次要复合终点，LVAD/心脏移植，或心血管死亡进行了不同类别的比较.
结果：LVC接近LMA与RR的进行性增加相关（ESV变化百分比：一致-47.0±5.9％，相邻-31.4±3.1%，不一致+0.4±3.7%)，而接近瘢痕与RR急剧下降相关(一致+10.7±12.9%,相邻+0.3±5.3%，不一致-31.3±4.4%，无疤痕-35.4±4.8％）。4个综合类别的LVC位置显示出显著的正RR梯度，类别越最优(I类-47.0±5.9%，II类-34.9±2.8%，III类-5.5±4.3%，IV级+3.4±5.2%)。免于心力衰竭住院的复合次要终点，LVAD/心脏移植，或心血管死亡证实了这些趋势，表明综合和个体LMA和瘢痕类别之间存在显着差异。
结论：综合CMR确定的LVC相对于LMA的位置和瘢痕对CRT的反应进行分层。
目的：根据心脏磁共振（CMR）测定的左心室阴极（LVC）相对于最新机械激活（LMA）和瘢痕的位置，分析CRT患者的逆重构（RR）和临床事件。
方法：这是一项对68名连续Q-LV引导的CRT-D和CRT-P受者的回顾性单中心研究。通过基于CMR的3D重建叠加在荧光图像上，LVC被分层为一致的，相邻,或与LMA（具有最新和最大的径向应变的3个节段）和疤痕（具有>50％疤痕透壁性的节段）不一致。RR的主要终点（以ESV变化百分比表示）和HF住院的次要复合终点，LVAD/心脏移植，或心血管死亡进行了不同类别的比较.
结果：LVC接近LMA与RR的进行性增加相关（ESV变化百分比：一致-47.0±5.9％，相邻-31.4±3.1%，不一致+0.4±3.7%)，而接近瘢痕与RR急剧下降相关(一致+10.7±12.9%,相邻+0.3±5.3%，不一致-31.3±4.4%，无疤痕-35.4±4.8％）。4个综合类别的LVC位置显示出显著的正RR梯度，类别越最优(I类-47.0±5.9%，II类-34.9±2.8%，III类-5.5±4.3%，IV级+3.4±5.2%)。免于心力衰竭住院的复合次要终点，LVAD/心脏移植，或心血管死亡证实了这些趋势，表明综合和个体LMA和瘢痕类别之间存在显着差异。
结论：综合CMR确定的LVC相对于LMA的位置和瘢痕对CRT的反应进行分层。
