Foley, Paul William Xavier (2011)
M.D. thesis, University of Birmingham.
Contemporary management of patients with heart failure (HF) includes treatment with cardiac resynchronisation therapy (CRT). The benefit of CRT results from several mechanisms, predominantly correction of dyssynchrony. The development of a novel method of measuring left ventricular global dyssynchrony using cardiovascular magnetic resonance (CMR), termed CMR-tissue synchronisation index (CMR-TSI) is described.
A study of 225 patients with HF who underwent CMR-TSI found that HF appears synonymous with dyssynchrony. The importance of myocardial scar is illustrated in a study of 95 patients which revealed a significantly higher mortality in patients undergoing CRT who had postero-lateral (PL) scar on CMR.
A study into the effects of a combination of CMR-TSI and scar imaging found that presence of either CMR-TSI >110ms or PL scar resulted in a worse outcome, whilst the presence of both was associated with the highest mortality.
A final study in 148 patients allowed the development of a risk score to predict mortality from CRT on the basis of 16 candidate variables. PL scar, dyssynchrony and creatine
discriminated between survivors and non-survivors and were used to derive the score. The score is discussed in the context of data derived from echocardiography and clinical
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