Cardiac resynchronization therapy guided by multimodality cardiac imaging

<jats:title>Abstract</jats:title><jats:sec><jats:title>Aims</jats:title><jats:p>Up to 30–45% of implanted patients are non‐responders to <jats:styled-content style="fixed-case">CRT</jats:styled-content>. We evaluated the role of a ‘<jats:styled-content style="fixed-case">CRT</jats:styled-content> team’ using cardiac magnetic resonance (<jats:styled-content style="fixed-case">CMR</jats:styled-content>) and longitudinal myocardial strain to identify the target area defined as the most delayed and viable region for <jats:styled-content style="fixed-case">LV</jats:styled-content> pacing.</jats:p></jats:sec><jats:sec><jats:title>Methods and results</jats:title><jats:p>A total of 100 heart failure patients candidates for <jats:styled-content style="fixed-case">CRT</jats:styled-content> divided into two groups were enrolled. Group 1 consisted of 50 consecutive patients scheduled for <jats:styled-content style="fixed-case">CRT</jats:styled-content> and prospectively included. Group 2 (control) consisted of 50 patients with a <jats:styled-content style="fixed-case">CRT</jats:styled-content> device implanted according to standard clinical practice and matched for age, sex, and <jats:styled-content style="fixed-case">LVEF</jats:styled-content> with group 1. Patients were evaluated at baseline and at 6‐month follow‐up. In group 1, patients underwent two‐dimensional speckle‐tracking assessment of longitudinal myocardial strain and <jats:styled-content style="fixed-case">CMR</jats:styled-content> imaging to identify the target area for <jats:styled-content style="fixed-case">LV</jats:styled-content> lead pacing. A positive response to <jats:styled-content style="fixed-case">CRT</jats:styled-content> was defined as a reduction of ≥15% of the <jats:styled-content style="fixed-case">LV</jats:styled-content> end‐systolic volume at 6‐month follow‐up. A total of 39 (78%) patients of group 1 were classified as responders to <jats:styled-content style="fixed-case">CRT</jats:styled-content> whilst in group 2, only 28 (56%) were responders (<jats:italic>P</jats:italic> = 0.019). The ‘<jats:styled-content style="fixed-case">CRT</jats:styled-content> team’ identified as target for <jats:styled-content style="fixed-case">LV</jats:styled-content> pacing the lateral area in 30 (60%) patients, and the anterolateral or posterolateral areas in 12 (24%) patients. In 8 (16%) patients, the target was far from the lateral area, in the anterior or posterior areas. The patients with concordant position exhibited the highest positive response (93.1%) to <jats:styled-content style="fixed-case">CRT</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Multimodality cardiac imaging as a guide for <jats:styled-content style="fixed-case">CRT</jats:styled-content> implantation is useful to increase response rate.</jats:p></jats:sec>