Document Detail

Effect of lateral wall scar on reverse remodeling with cardiac resynchronization therapy.
MedLine Citation:
PMID:  19959118     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Up to 50% of patients do not respond to cardiac resynchronization therapy (CRT). Recent work has focused on quantifying left ventricular (LV) scar, with conflicting results. Some studies have shown that the global extent of LV scar is important, whereas others found the size of the septal or lateral wall scar to be key.
OBJECTIVE: This study sought to examine the relative importance of the size and distribution of LV scar in determining reverse remodeling to CRT.
METHODS: Forty-nine patients had pre-implantation rubidium-82 and fluorine-18-fluorodeoxyglucose positron emission tomography scanning. Total and regional LV scar size were calculated. Response to CRT was pre-specified as > or =10% improvement in LV end-systolic volume and/or > or =5% absolute ejection fraction improvement.
RESULTS: Responders (n = 31) had significantly less lateral wall scar than responders (5.6% compared with 24.5%, P = .008) but a similar extent of global and septal scar. In the ischemic group, responders' median lateral wall scar size was 11.2% (IQR 0.0 to 31.2), compared with 47.8% (IQR 21.2 to 73.4) P = .052. In the ischemic group, for each 5% absolute decrease in lateral scar size, the odds ratio of being a responder was 1.87 (95% CI: 1.11 to 3.15, P = .018). In the nonischemic group, median lateral wall scar size of responders was 3.4% (IQR 0.0 to 10.3) compared with the nonresponders, 14.4% (IQR 9.0 to 27.8), P = .046.
CONCLUSION: Responders had significantly less lateral wall scar than nonresponders, but a similar extent of global and septal scar. This held true in both ischemic and nonischemic cardiomyopathy patients.
David Birnie; Rob A DeKemp; Terence D Ruddy; Anthony S Tang; Ann Guo; Kathryn Williams; Richard Wassenar; Michel Lalonde; Rob S Beanlands
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-08-14
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  6     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-12-04     Completed Date:  2011-01-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1721-6     Citation Subset:  IM    
University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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MeSH Terms
Bundle-Branch Block / therapy*
Cardiac Resynchronization Therapy*
Cardiomyopathies / etiology,  pathology*,  radionuclide imaging,  therapy*
Confidence Intervals
Fluorodeoxyglucose F18
Heart Ventricles / pathology*,  radionuclide imaging
Middle Aged
Myocardial Ischemia / complications
Odds Ratio
Positron-Emission Tomography
Prospective Studies
ROC Curve
Statistics, Nonparametric
Tomography, Emission-Computed, Single-Photon
Ventricular Remodeling
Reg. No./Substance:
63503-12-8/Fluorodeoxyglucose F18; 7440-17-7/Rubidium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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