Archived Comments for:
A prospective evaluation of cardiovascular magnetic resonance measures of dyssynchrony in the prediction of response to cardiac resynchronization therapy
Suggestion for improving CMR dys-synchrony assessment further
Saul Myerson, University of Oxford
21 November 2014
Thank you Sohal and colleagues for an interesting paper. I think there is a way of improving your assessment further, by integrating two of the aspects you have examined separately, which would be interesting to assess:
Scar tissue will never contract again, and therefore should be excluded from any assessment of potential improved synchrony post-CRT. By including it in any dys-synchrony assessment, this confuses dys-synchronous but viable tissue (which may respond to resynchronisation pacing) with dys-synchronous but scarred tissue, which won't respond. To my surprise, no previous CMR study has considered this aspect apart from a crude assessment of scar size and it's association with outcome (separately from the dys-synchrony assessment).
I would suggest a simple re-analysis of your data, by first excluding any segments where there is significant scar and then assessing the SDI volume change in the remaining segments - I suspect this would provide a better indication of the potential for improvement post CRT.
CMR is uniquely placed to assess both scar and regional volume change (which you have shown to be very useful), and integrating the two may be particularly beneficial.
Suggestion for improving CMR dys-synchrony assessment further
21 November 2014
Thank you Sohal and colleagues for an interesting paper. I think there is a way of improving your assessment further, by integrating two of the aspects you have examined separately, which would be interesting to assess:
Scar tissue will never contract again, and therefore should be excluded from any assessment of potential improved synchrony post-CRT. By including it in any dys-synchrony assessment, this confuses dys-synchronous but viable tissue (which may respond to resynchronisation pacing) with dys-synchronous but scarred tissue, which won't respond. To my surprise, no previous CMR study has considered this aspect apart from a crude assessment of scar size and it's association with outcome (separately from the dys-synchrony assessment).
I would suggest a simple re-analysis of your data, by first excluding any segments where there is significant scar and then assessing the SDI volume change in the remaining segments - I suspect this would provide a better indication of the potential for improvement post CRT.
CMR is uniquely placed to assess both scar and regional volume change (which you have shown to be very useful), and integrating the two may be particularly beneficial.
Regards,
Saul Myerson
Competing interests
None