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Quantitative Analysis of Intraventricular Dyssynchrony Using Wall Thickness by Multidetector Computed Tomography

Quynh A. Truong, MD^_*,_*, Jagmeet P. Singh, MD, DPhil, Christopher P. Cannon, MD, Ammar Sarwar, MD^_*, Khurram Nasir, MD, MPH^_*, Angelo Auricchio, MD, PhD, Francesco F. Faletra, MD, Antonio Sorgente, MD, Cristina Conca, MD, Tiziano Moccetti, MD, Mark Handschumacher, BS, Thomas J. Brady, MD^_*, Udo Hoffmann, MD, MPH^_*

^_* Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Cardiocentro Ticino, Lugano, Switzerland

^_* Reprint requests and correspondence: Dr. Quynh A. Truong, Cardiac MR PET CT Program, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, Massachusetts 02114 (Email: qtruong{at}partners.org).

Objectives: We sought to determine the feasibility of cardiac computed tomography (CT) to detect significant differences in the extent of left ventricular dyssynchrony in heart failure (HF) patients with wide QRS, HF patients with narrow QRS, and age-matched controls.

Background: The degree of mechanical dyssynchrony has been suggested as a predictor of response to cardiac resynchronization therapy. There have been no published reports of dyssynchrony assessment with the use of CT.

Methods: Thirty-eight subjects underwent electrocardiogram-gated contrast-enhanced 64-slice multidetector CT. The left ventricular endocardial and epicardial boundaries were delineated from short-axis images reconstructed at 10% phase increments of the cardiac cycle. Global and segmental CT dyssynchrony metrics that used changes in wall thickness, wall motion, and volume over time were assessed for reproducibility. We defined a global metric using changes in wall thickness as the dyssynchrony index (DI).

Results: The DI was the most reproducible metric (interobserver and intraobserver intraclass correlation coefficients 0.94, p < 0.0001) and was used to determine differences between the 3 groups: HF-wide QRS group (ejection fraction [EF] 22 ± 8%, QRS 163 ± 28 ms), HF-narrow QRS (EF 26 ± 7%, QRS 96 ± 11 ms), and age-matched control subjects (EF 64 ± 5%, QRS 87 ± 9 ms). Mean DI was significantly different between the 3 groups (HF-wide QRS: 152 ± 44 ms, HF-narrow QRS: 121 ± 58 ms, and control subjects: 65 ± 12 ms; p < 0.0001) and greater in the HF-wide QRS (p < 0.0001) and HF-narrow QRS (p = 0.005) groups compared with control subjects. We found that DI had a good correlation with 2-dimensional (r = 0.65, p = 0.012) and 3-dimensional (r = 0.68, p = 0.008) echocardiographic dyssynchrony.

Conclusions: Quantitative assessment of global CT-derived DI, based on changes in wall thickness over time, is highly reproducible and renders significant differences between subjects most likely to have dyssynchrony and age-matched control subjects.

Key Words: imaging • tomography • heart failure • pacing • dyssynchrony

Abbreviations and Acronyms   2D = two-dimensional   3D = three-dimensional   CAD = coronary artery disease   CRT = cardiac resynchronization therapy   CT = computed tomography   DI = dyssynchrony index   ECG = electrocardiography   EF = ejection fraction   HF = heart failure   ICC = intraclass correlation coefficient   LV = left ventricular

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