Nicht invasive Bildgebung vor kardialer Resynchronisationstherapie

Abstract

The indication for cardiac resynchronisation therapy (CRT) with biventricular pacing for the treatment of advanced systolic heart failure is well established. The underlying principle is to resynchronize the dyssynchronous mechanical myocardial contraction patterns in patients with delayed electrical conduction, identified by a prolonged QRS complex in the 12-lead electrocardiogram (ECG). However, the correlation between QRS width and mechanical dyssynchrony is limited, in particular in cases with only moderate QRS prolongation of less than 150 ms. Cardiac imaging techniques such as echocardiography, magnetic resonance imaging (MRI) and cardiac CT allow better to identify the presence and extent of mechanical dyssynchrony and may thus help to overcome the limitations of the ECG. Furthermore these techniques may add important information about the amount of recruitable (viable) myocardium and on concomitant valvular diseases. This review article discusses the role of cardiac imaging before CRT implantation, with particular focus on echocardiography for the assessment of mechanical dyssynchrony and the role of cardiac MRI and CT for the assessment of myocardial viability and coronary artery disease.

Literatur

• 1 Kass D A, Chen C H, Curry C. et al . Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay.  Circulation. 1999;  99 1567-1573
• 2 Helm R H, Leclercq C, Faris O P. et al . Cardiac dyssynchrony analysis using circumferential versus longitudinal strain: implications for assessing cardiac resynchronization.  Circulation. 2005;  111 2760-2767
• 3 Prinzen F W, Augustijn C H, Arts T. et al . Redistribution of myocardial fiber strain and blood flow by asynchronous activation.  Am J Physiol. 1990;  259 H300-H308
• 4 Verbeek X A, Vernooy K, Peschar M. et al . Quantification of interventricular asynchrony during LBBB and ventricular pacing.  Am J Physiol Heart Circ Physiol. 2002;  283 H1370-H1378
• 5 Grines C L, Bashore T M, Boudoulas H. et al . Functional abnormalities in isolated left bundle branch block. The effect of interventricular asynchrony.  Circulation. 1989;  79 845-853
• 6 Breithardt O A, Stellbrink C, Kramer A P. et al . Echocardiographic quantification of left ventricular asynchrony predicts an acute hemodynamic benefit of cardiac resynchronization therapy.  J Am Coll Cardiol. 2002;  40 536-545
• 7 Breithardt O A, Stellbrink C, Herbots L. et al . Cardiac Resynchronization Therapy Can Reverse Abnormal Myocardial Strain Distribution in Patients With Heart Failure and Left Bundle-Branch Block.  J Am Coll Cardiol. 2003;  42 486-494
• 8 Weil J, Schunkert H. Pathophysiologie der chronischen Herzinsuffizienz.  Clin Res Cardiol. 2006;  95 (Suppl 4) 1-15
• 9 Claus P, Bijnens B, Breithardt O A. et al . Why Ischemic Hearts Respond Less to Cardiac Resynchronisation Therapy. A Modeling Study. Magnin IE et al. (ed) Functional Imaging and Modelling of the Heart. 2003: 287-294
• 10 Tavazzi L. Ventricular pacing: a promising new therapeutic strategy in heart failure. For whom?.  Eur Heart J. 2000;  21 1211-1214
• 11 Fauchier L, Marie O, Casset-Senon D. et al . Reliability of QRS duration and morphology on surface electrocardiogram to identify ventricular dyssynchrony in patients with idiopathic dilated cardiomyopathy.  Am J Cardiol. 2003;  92 341-344
• 12 Bleeker G B, Schalij M J, Molhoek S G. et al . Relationship Between QRS Duration and Left Ventricular Dyssynchrony in Patients with End-Stage Heart Failure.  J Cardiovasc Electrophysiol. 2004;  15 544-549
• 13 Donal E, Tournoux F, Leclercq C. et al . Assessment of longitudinal and radial ventricular dyssynchrony in ischemic and nonischemic chronic systolic heart failure: a two-dimensional echocardiographic speckle-tracking strain study.  J Am Soc Echocardiogr. 2008;  21 58-65
• 14 Sweeney M O, van Bommel R J, Schalij M J. et al . Analysis of ventricular activation using surface electrocardiography to predict left ventricular reverse volumetric remodeling during cardiac resynchronization therapy.  Circulation. 2010;  121 626-634
• 15 Cleland J G, Daubert J C, Erdmann E. et al . The Effect of Cardiac Resynchronization on Morbidity and Mortality in Heart Failure.  N Engl J Med. 2005;  352 1539-1549
• 16 Bristow M R, Saxon L A, Boehmer J. et al . Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure.  N Engl J Med. 2004;  350 2140-2150
• 17 Cazeau S, Leclercq C, Lavergne T. et al . Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay.  N Engl J Med. 2001;  344 873-880
• 18 Abraham W T, Fisher W G, Smith A L. et al . Cardiac resynchronization in chronic heart failure.  N Engl J Med. 2002;  346 1845-1853
• 19 Vardas P E, Auricchio A, Blanc J J. et al . Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association.  Eur Heart J. 2007;  28 2256-2295
• 20 Richardson M, Freemantle N, Calvert M J. et al . Predictors and treatment response with cardiac resynchronization therapy in patients with heart failure characterized by dyssynchrony: a pre-defined analysis from the CARE-HF trial.  Eur Heart J. 2007;  28 1827-1834
• 21 Auricchio A, Stellbrink C, Block M. et al . Effect of pacing chamber and atrioventricular delay on acute systolic function of paced patients with congestive heart failure.  Circulation. 1999;  99 2993-3001
• 22 Moss A J, Hall W J, Cannom D S. et al . Cardiac-resynchronization therapy for the prevention of heart-failure events.  N Engl J Med. 2009;  361 1329-1338
• 23 Bleeker G B, Kaandorp T AM, Lamb H J. et al . Effect of postero-lateral scar tissue on clinical and echocardiographic improvement following cardiac resynchronization therapy.  Circulation. 2006;  113 969-976
• 24 Chalil S, Stegemann B, Muhyaldeen S A. et al . Effect of posterolateral left ventricular scar on mortality and morbidity following cardiac resynchronization therapy.  Pacing Clin Electrophysiol. 2007;  30 1201-1209
• 25 Mele D, Agricola E, Galderisi M. et al . Echocardiographic myocardial scar burden predicts response to cardiac resynchronization therapy in ischemic heart failure.  J Am Soc Echocardiogr. 2009;  22 702-708
• 26 Adelstein E C, Saba S. Scar burden by myocardial perfusion imaging predicts echocardiographic response to cardiac resynchronization therapy in ischemic cardiomyopathy.  Am Heart J. 2007;  153 105-112
• 27 Birnie D, DeKemp R A, Ruddy T D. et al . Effect of lateral wall scar on reverse remodeling with cardiac resynchronization therapy.  Heart Rhythm. 2009;  6 1721-1726
• 28 Cazeau S, Gras D, Lazarus A, Ritter P, Mugica J. Multisite stimulation for correction of cardiac asynchrony.  Heart. 2000;  84 579-581
• 29 Breithardt O A, Stellbrink C, Franke A. et al . Acute effects of cardiac resynchronization therapy on left ventricular Doppler indices in patients with congestive heart failure.  Am Heart J. 2002;  143 34-44
• 30 Stockburger M, Fateh-Moghadam S, Nitardy A. et al . Optimization of cardiac resynchronization guided by Doppler echocardiography:haemodynamic improvement and intraindividual variability with different pacing configurations and atrioventricular delays.  Europace. 2006;  8 881-886
• 31 Stockburger M, Fateh-Moghadam S, Nitardy A. et al . Baseline Doppler parameters are useful predictors of chronic left ventricular reduction in size by cardiac resynchronization therapy.  Europace. 2008;  10 69-74
• 32 Rouleau F, Merheb M, Geffroy S. et al . Echocardiographic assessment of the interventricular delay of activation and correlation to the QRS width in dilated cardiomyopathy.  Pacing Clin Electrophysiol. 2001;  24 1500-1506
• 33 Cazeau S J, Daubert J C, Tavazzi L. et al . Responders to cardiac resynchronization therapy with narrow or intermediate QRS complexes identified by simple echocardiographic indices of dyssynchrony: the DESIRE study.  Eur J Heart Fail. 2008;  10 273-280
• 34 Jansen A H, van Dantzig J, Bracke F. et al . Qualitative observation of left ventricular multiphasic septal motion and septal-to-lateral apical shuffle predicts left ventricular reverse remodeling after cardiac resynchronization therapy.  Am J Cardiol. 2007;  99 966-969
• 35 Parsai C, Bijnens B, Sutherland G R. et al . Toward understanding response to cardiac resynchronization therapy: left ventricular dyssynchrony is only one of multiple mechanisms.  Eur Heart J. 2009;  30 940-949
• 36 Marsan N A, Breithardt O A, Delgado V. et al . Predicting response to CRT. The value of two- and three-dimensional echocardiography.  Europace. 2008;  10 Suppl 3 iii73-iii79
• 37 Kapetanakis S, Kearney M T, Siva A. et al . Real-time three-dimensional echocardiography: a novel technique to quantify global left ventricular mechanical dyssynchrony.  Circulation. 2005;  112 992-1000
• 38 Marsan N A, Bleeker G B, Ypenburg C. et al . Real-time three-dimensional echocardiography permits quantification of left ventricular mechanical dyssynchrony and predicts acute response to cardiac resynchronization therapy.  J Cardiovasc Electrophysiol. 2008;  19 392-399
• 39 Porciani M C, Rao C M, Mochi M. et al . A real-time three-dimensional echocardiographic validation of an intracardiac electrogram-based method for optimizing cardiac resynchronization therapy.  Pacing Clin Electrophysiol. 2008;  31 56-63
• 40 Eitel C, Doring M, Gaspar T. et al . Cardiac resynchronization therapy with individualized placement of two left ventricular leads at the sites of latest mechanical left ventricular contraction: guided by 3D-echocardiography and coronary sinus rotation angiography.  Eur J Heart Fail. 2010;  12 411-414
• 41 Breithardt O A, Claus P, Sutherland G R. Do we understand who benefits from resynchronisation therapy?.  Eur Heart J. 2004;  25 535-536
• 42 De Boeck B W, Meine M, Leenders G E. et al . Practical and conceptual limitations of tissue Doppler imaging to predict reverse remodelling in cardiac resynchronisation therapy.  Eur J Heart Fail. 2008;  10 281-290
• 43 Rocchi G, Bertini M, Biffi M. et al . Exercise stress echocardiography is superior to rest echocardiography in predicting left ventricular reverse remodelling and functional improvement after cardiac resynchronization therapy.  Eur Heart J. 2009;  30 89-97
• 44 Moonen M, O’Connor K, Magne J. et al . Stress echocardiography for selecting potential responders to cardiac resynchronisation therapy.  Heart. 2010;  96 1142-1146
• 45 Parsai C, Baltabaeva A, Anderson L. et al . Low-dose dobutamine stress echo to quantify the degree of remodelling after cardiac resynchronization therapy.  Eur Heart J. 2009;  30 950-958
• 46 Mullens W, Grimm R A, Verga T. et al . Insights from a cardiac resynchronization optimization clinic as part of a heart failure disease management program.  J Am Coll Cardiol. 2009;  53 765-773
• 47 Bader H, Garrigue S, Lafitte S. et al . Intra-left ventricular electromechanical asynchrony. A new independent predictor of severe cardiac events in heart failure patients.  J Am Coll Cardiol. 2004;  43 248-256
• 48 Bax J J, Marwick T H, Molhoek S G. et al . Left ventricular dyssynchrony predicts benefit of cardiac resynchronization therapy in patients with end-stage heart failure before pacemaker implantation.  Am J Cardiol. 2003;  92 1238-1240
• 49 Yu C M, Bax J J, Monaghan M, Nihoyannopoulos P. Echocardiographic evaluation of cardiac dyssynchrony for predicting a favourable response to cardiac resynchronisation therapy.  Heart. 2004;  90 vi17-vi22
• 50 Chung E S, Leon A R, Tavazzi L. et al . Results of the Predictors of Response to CRT (PROSPECT) Trial.  Circulation. 2008;  117 2608-2616
• 51 Beshai J F, Grimm R A, Nagueh S F. et al . Cardiac-resynchronization therapy in heart failure with narrow QRS complexes.  N Engl J Med. 2007;  357 2461-2471
• 52 Lafitte S, Reant P, Zaroui A. et al . Validation of an echocardiographic multiparametric strategy to increase responders patients after cardiac resynchronization:a multicentre study.  Eur Heart J. 2009;  30 2835-2837
• 53 van de Veire N R, Marsan N A, Schuijf J D. et al . Noninvasive imaging of cardiac venous anatomy with 64-slice multi-slice computed tomography and noninvasive assessment of left ventricular dyssynchrony by 3-dimensional tissue synchronization imaging in patients with heart failure scheduled for cardiac resynchronization therapy.  Am J Cardiol. 2008;  101 1023-1029
• 54 Jongbloed M R, Lamb H J, Bax J J. et al . Noninvasive visualization of the cardiac venous system using multislice computed tomography.  J Am Coll Cardiol. 2005;  45 749-753
• 55 Lumia D, Lagana D, Cani A. et al . MDCT evaluation of the cardiac venous system.  Radiol Med. 2009;  114 837-851
• 56 van de Veire N R, Delgado V, Schuijf J D. et al . The role of non-invasive imaging in patient selection.  Europace. 2009;  11(Suppl 5) v32-v39
• 57 Taylor A J, Elsik M, Broughton A. et al . Combined dyssynchrony and scar imaging with cardiac magnetic resonance imaging predicts clinical response and long-term prognosis following cardiac resynchronization therapy.  Europace. 2010;  12 708-713
• 58 Sturdivant J L, Gold M R. Myocardial contractile reserve as a predictor of cardiac resynchronization therapy response.  Heart Rhythm. 2006;  3 414-415
• 59 Ypenburg C, Schalij M J, Bleeker G B. et al . Impact of viability and scar tissue on response to cardiac resynchronization therapy in ischaemic heart failure patients.  Eur Heart J. 2007;  28 33-41
• 60 White J A, Yee R, Yuan X. et al . Delayed enhancement magnetic resonance imaging predicts response to cardiac resynchronization therapy in patients with intraventricular dyssynchrony.  J Am Coll Cardiol. 2006;  48 1953-1960
• 61 Prinzen F W, Hunter W C, Wyman B T, McVeigh E R. Mapping of regional myocardial strain and work during ventricular pacing: experimental study using magnetic resonance imaging tagging.  J Am Coll Cardiol. 1999;  33 1735-1742
• 62 Westenberg J J, Lamb H J, van der Geest R J. et al . Assessment of left ventricular dyssynchrony in patients with conduction delay and idiopathic dilated cardiomyopathy: head-to-head comparison between tissue doppler imaging and velocity-encoded magnetic resonance imaging.  J Am Coll Cardiol. 2006;  47 2042-2048
• 63 Lardo A C, Abraham T P, Kass D A. Magnetic resonance imaging assessment of ventricular dyssynchrony: current and emerging concepts.  J Am Coll Cardiol. 2005;  46 2223-2228
• 64 Koos R, Neizel M, Schummers G. et al . Feasibility and initial experience of assessment of mechanical dyssynchrony using cardiovascular magnetic resonance and semi-automatic border detection.  J Cardiovasc Magn Reson. 2008;  10 49