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LV lead position analysis by myocardial deformation imaging predictive of functional improvement

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The use of myocardial deformation imaging during left ventricular pacing was able to determine lead positioning, results from a study suggested.

Researchers evaluated whether LV lead position in cardiac resynchronization therapy (CRT) can be determined by myocardial deformation imaging using fluoroscopy and myocardial strain analysis during LV pacing. The study included 56 patients (mean age 53 ± 5 years,) undergoing CRT, fluoroscopy and two myocardial deformation imaging-based approaches. Twelve-month echocardiography was performed to determine LV remodeling and functional improvement. Optimal LV lead position was defined as immediate neighboring of the determined LV lead position to the segment with latest systolic strain prior to CRT.

According to the results, LV lead position that was determined during pacing correlated to the LV lead position determined by fluoroscopy. Patients with optimal LV lead position demonstrated a greater improvement in LV ejection fraction than those with nonoptimal lead positioning (12 ± 4% vs. 7± 3%, P<0.001), and also saw a decrease in end-diastolic volume vs. those with nonoptimal LV lead position (28 ±13 mL vs. 14 ± 8 mL, P<.001) . The determination of the LV lead positioning based on myocardial deformation imaging during pacing showed greater discriminatory power for improvement of EF (difference P<.001) than deformation imaging with biventricular pacing (P<.007) and fluoroscopy (P<.053).

“The analysis of the myocardial deformation sequence during pure LV pacing allows determination of CRT LV positioning,” the researchers concluded.“The definition of the LV lead position based on myocardial deformation analysis during pure LV pacing allows better distinction between optimal and nonoptimal LV lead position as indicated by the improvement in LV function and reverse remodeling at 12-month follow-up than definition of the LV lead position by fluoroscopy.”

Becker M. J Am Coll Cardiol. 2010;3:472-481

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