Mechanical Dyssynchrony in Heart Failure and Implications for Response and Guidance of Cardiac Resynchronisation Therapy

Abstract

Cardiac Resynchronisation therapy (CRT) is an established treatment for heart failure patients with severe left ventricular (LV) dysfunction and widened QRS duration. Response to CRT remains variable. Up to 30% of patients do not gain symptomatic benefit with numbers that fail to reverse remodel (RR) even higher. Strategies to improve response rates have focused on pre-implant dyssynchrony following assumption that electrical dyssynchrony translates into mechanical dyssynchrony. Other factors that influence outcome are presence of myocardial scar and LV lead position. Cardiac magnetic resonance (CMR) imaging can quantify global myocardial dyssynchrony in different modalities; volume change, muscle thickening and strain. Understanding how these measures of dyssynchrony relate to each other is important when considering how they can assist patient selection. In addition the role of CMR to assess cardiac anatomy and scar means that it is ideally placed as an imaging modality to provide comprehensive evaluation of heart failure patients prior to CRT. This thesis aims to explore the feasibility of using CMR imaging as an inclusive imaging method to assess patients for CRT. Forty-eight patients fulfilling the criteria for CRT were recruited (43 male, 63.8±13.9 years). 25 had dilated cardiomyopathy (DCM) and 23 ischaemic cardiomyopathy (ICM). All patients underwent a CMR and echocardiographic.

Date of Award	1 Feb 2013
Original language	English
Awarding Institution	King's College London
Supervisor	Reza Razavi (Supervisor)