The role of feature-tracking cardiovascular magnetic resonance in optimising response to cardiac resynchronisation therapy

Taylor, Robin James (2018). The role of feature-tracking cardiovascular magnetic resonance in optimising response to cardiac resynchronisation therapy. University of Birmingham. M.D.

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Abstract

Cardiac resynchronisation therapy (CRT) forms part of the established treatment for heart failure, but individual response is variable. Deformation imaging permits assessment of myocardial mechanics. Echocardiography-based techniques are unable to refine patient selection for CRT, although can identify preferential late mechanically activated (LMA) targets for lead placement. Feature-tracking (FT) is a rapid cardiac magnetic resonance (CMR) deformation technique performed on standard acquisition, overcoming the limitations of myocardial tagging (MT). This work aims to validate FT-CMR against MT and establish its role in patient selection and left ventricular (LV) lead deployment in the context of CRT.A validation study performed on healthy volunteers and cardiomyopathy patients demonstrated good intra- and inter-observer variability, and reasonable agreement compared with MT. In a retrospective observational study of CRT recipients, greater baseline dyssynchrony did not predict LV reverse remodelling (LVRR) or symptomatic response at 6 months, but low strain was associated with a high risk of cardiovascular mortality. Furthermore, lead deployment over non-scarred, LMA myocardium, assessed using late gadolinium enhancement (LGE) and FT-CMR was associated with better LVRR and long term survival. FT-CMR showed no ability to enhance patient selection for CRT but, coupled with LGE CMR, has a role in guiding LV lead deployment.

Type of Work:

Thesis (Higher Doctorates > M.D.)

Award Type:

Higher Doctorates > M.D.

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