Cardiac Resynchronization Therapy (CRT) fails to provide benefit in up to one-third of patients. Maximizing the geographic separation of right and left ventricular pacing lead sites has been suggested as one way to improve response. Cardiac CT provides an opportunity to explore 3-dimensional inter-lead distance (ILD) measures for the prediction of CRT response. The objective of this study was to investigate associations between standardized measures of ILD by cardiac CT and echocardiographic response to CRT. Forty-two consecutive patients undergoing CRT had serial clinical and echocardiographic evaluations performed in addition to a post-procedural cardiac-gated CT with blinded measurement of direct and circumferential (via the myocardium) ILD measures. Clinical response to CRT, the primary clinical outcome, was defined as a ≥15% reduction in LVESV using echocardiography at 6-months. The mean age and ejection fraction was 63.6 ± 8.9 years and 25.2 ± 7.8%, respectively. The primary outcome occurred in 35 of 42 patients (83%). Both direct and circumferential CT-based ILD measures were associated with the primary outcome by univariate analysis. Receiver Operator Characteristic analysis identified Circumferential ILD to have the strongest predictive accuracy (AUC 0.78). Inter- and intra-observer reproducibility of CT-derived ILD measures was excellent. Circumferential ILD measures on cardiac CT are predictive of clinical response to CRT. Incorporation of these measures into the selection of optimal pacing targets, particularly from pre-procedural CT coronary vein imaging may be of therapeutic benefit and warrants further investigation.
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Magnetic resonance imaging
Cardiac resynchronization therapy
Left bundle branch block
Left ventricular ejection fraction
New York Heart Association
Glomerular filtration rate
Quality of life
Minnesota living with heart failure questionnaire
Left ventricular end-diastolic volume
Left ventricular end-systolic volume
Implantable cardiac defibrillator
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All authors have read and agree to the manuscript as written. JAW, PG, LP and MD have had full access to the study data and take responsibility for its integrity. Dr. White is supported by a Early Investigator award with the Heart and Stroke Foundation of Alberta, Canada. Dr. Drangova is supported by a Career Investigator award from the Heart and Stroke Foundation of Ontario. Dr. Krahn is a Career Investigator of the Heart and Stroke Foundation of Ontario. This research was supported in part by Heart and Stroke Foundation Grant # NA6488 (PI: JAW), the Canada Foundation of Innovation Leaders Opportunity Fund, the Ontario Research Fund, Imaging in Cardiovascular Therapeutics grant and the Program for Experimental Medicine (POEM).
Conflicts of interest
Drs. Modi, Yee, Scholl, Stirrat, Wong, Lydell, Kotha, Gula, Skanes, Leong-Sit, and McCarty have no conflicts of interest or financial disclosures. James A White is a Early Investigator and Maria Drangova is a Career Scientist with the Heart and Stroke Foundation of Ontario, Canada. Dr. White receives grant research support from Circle Cardiovascular Inc. Canada, has received consultative fees from Medtronic, Inc., and is shareholder in Cohesic Inc.
An erratum to this article is available at https://doi.org/10.1007/s10554-017-1144-9.
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Modi, S., Yee, R., Scholl, D. et al. Ventricular pacing site separation by cardiac computed tomography: validation for the prediction of clinical response to cardiac resynchronization therapy. Int J Cardiovasc Imaging 33, 1433–1442 (2017). https://doi.org/10.1007/s10554-017-1120-4
- Cardiac resynchronization therapy (CRT)
- Lead separation
- Cardiac computed tomography
- Cardiac failure
- CRT response
- Inter-lead distance
- Left ventricular lead