Left ventricular dyssynchrony in patients with left bundle branch block and patients after myocardial infarction: integration of mechanics and viability by cardiac magnetic resonance

Rutz, Andrea K. ; Manka, Robert ; Kozerke, Sebastian ; Roas, Susanne ; Boesiger, Peter ; Schwitter, Juerg

In: European Heart Journal, 2009, vol. 30, no. 17, p. 2117-2127

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    Aims To quantify left ventricular (LV) dyssynchrony in patients with left bundle branch block (LBBB) and in patients after myocardial infarction (MI) applying an accelerated three-dimensional (3D) tagging cardiac magnetic resonance (CMR) technique, and to combine dyssynchrony information with viability data obtained by late gadolinium enhancement (LGE) CMR. Methods and results Thirty-two patients (59 ± 11 years) after first MI (PatsMI), 10 patients (63 ± 10 years) with LBBB (ejection fraction < 40%; PatsLBBB<40), 13 patients (63 ± 11) with LBBB (ejection fraction ≥ 40%; PatsLBBB≥40), and 15 healthy controls (53 ± 10 years) underwent 3D tagging CMR and LGE imaging at 1.5 T. As a measure of mechanical LV dyssynchrony, the standard deviation of Tmax over the LV, the circumferential uniformity ratio estimate (CURE) index, and a segmental-based circumferential systolic dyssynchrony index (SDI) were calculated. All three parameters detected significantly increased circumferential dyssynchrony in patients compared with controls. The CURE and SDI showed a good correlation (r = 0.93, P < 0.0001) and detected most severe dyssynchrony in PatsLBBB<40 (P < 0.001 vs. controls, P < 0.005 vs. PatsMI). Systolic dyssynchrony index additionally allowed integration of localized viability information to yield SDIviable which was highest in PatsLBBB<40. Conclusion Dyssynchrony patterns in the LV can be quantified globally and regionally by 3D tagging CMR. Combination of viability and dyssynchrony information allows for a comprehensive dyssynchrony quantification in patients with LBBB or post-MI. Future studies are required to test the value of the method to predict responsiveness to resynchronization