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. 2025 Mar 28;27(4):euaf043.
doi: 10.1093/europace/euaf043.

Tissue characterization using cardiac magnetic resonance imaging and response to cardiac resynchronization therapy

Se-Eun Kim  1 , Jaewon Oh  2 , Yoo Jin Hong  3 , Daehoon Kim  2 , Hee Tae Yu  2 , Chan Joo Lee  2 , Tae-Hoon Kim  2 , Jae-Sun Uhm  2 , Boyoung Joung  2 , Hui-Nam Pak  2 , Moon-Hyoung Lee  2 , Young Jin Kim  3 , Seok-Min Kang  2
Affiliations

Tissue characterization using cardiac magnetic resonance imaging and response to cardiac resynchronization therapy

Se-Eun Kim et al. Europace. .

Abstract

Aims: Cardiac magnetic resonance (CMR) imaging for tissue characterization offers valuable insights for risk stratification among patients with cardiomyopathy. This study aimed to assess the prognostic value of CMR-based tissue characterization in predicting response to cardiac resynchronization therapy (CRT) in patients with non-ischaemic cardiomyopathy (NICM).

Methods and results: Retrospective analysis was performed on CMR data from NICM patients before CRT implantation. Various CMR parameters, including the late gadolinium enhancement (LGE), native T1, T2, and extracellular volume (ECV), were analysed. Among the 101 patients (mean age: 66 years, male: 52.5%), 72 (71.3%) were CRT responders. The CRT responders had lower LGE burden (13.1 vs. 35.3%, P < 0.001), native T1 (1334.5 vs. 1371.6 ms, P = 0.012), T2 (42.2 vs. 45.7 ms, P < 0.001), and ECV (30.8 vs. 36.8%, P < 0.001) compared with CRT non-responders. After adjusting for other risk factors, LGE burden ≤ 20% [odds ratio (OR): 22.61, 95% confidence interval (CI): 4.73-176.68, P < 0.001], ECV ≤ 34% (OR: 15.93, 95% CI: 3.01-115.13, P = 0.002), and T2 ≤ 45 ms (OR: 8.10, 95% CI: 1.82-43.75, P = 0.008) were identified as predictors of good CRT response and favourable clinical outcomes (log-rank P < 0.001).

Conclusion: Cardiac magnetic resonance-based tissue parameters effectively predict CRT response and clinical outcomes in patients with NICM, independently of conventional predictors.

Keywords: Cardiac magnetic resonance imaging; Cardiac resynchronization therapy; Late gadolinium enhancement; Mapping value; Tissue characterization.

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Conflict of interest statement

Conflict of interest: none declared

Figures

Graphical Abstract
Graphical Abstract
Cardiac magnetic resonance tissue parameters as predictors for CRT response in NICM. Among 101 patients who underwent CMR before CRT implantation, 71.3% were CRT responders, who had lower LGE burden, baseline T1, T2, and ECV values. In contrast, 28.7% were CRT non-responders, who had higher LGE burden, baseline T1, T2, and ECV values. Late gadolinium enhancement burden ≤ 20%, ECV ≤ 34%, and T2 ≤ 45 ms were independent predictors of good CRT response and were associated with favourable clinical outcomes. CMR, cardiac magnetic resonance; CRT, cardiac resynchronization therapy; ECV, extracellular volume; LGE, late gadolinium enhancement; NICM, non-ischaemic cardiomyopathy.
Figure 1
Figure 1
Receiver operating characteristic curves displaying CMR parameters as predictors of CRT response. AUC, area under the ROC curve; CI, confidence interval; CRT, cardiac resynchronization therapy; ECV, extracellular volume; LGE, late gadolinium enhancement; ROC, receiver operating characteristics.
Figure 2
Figure 2
Clinical outcomes according to ECV and LGE burden. ECV, extracellular volume; LGE, late gadolinium enhancement.
See this image and copyright information in PMC

Comment in

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