Revisit the Value of Imaging in Best Using CArdiac Resynchronization Therapy

Study Overview
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Brief Summary
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Many studies have shown the benefits of cardiac resynchronization therapy (CRT) with biventricular pacing in patients with heart failure with left ventricular dysfunction. CRT restores contraction coordination between different regions of the left ventricle, which yields a significant improvement in LV systolic function, symptoms, exercise tolerance and quality of life. In the longer term, treatment with resynchronization induces a reverse remodeling of the left ventricle and a decrease in mortality and morbidity (hospitalization for heart failure). Nevertheless, even if a majority of patients treated with CRT feel the benefit, some (up to 40% depending on the response criteria of CRT) do not experience significant improvement (nonresponders). Echocardiography and imaging have not so far demonstrated their added value to optimize delivery of CRT. Monocentric promising work on limited numbers of patients, however, were carried out. Meanwhile, equipment for delivering CRT evolves and new probes with four poles stimulation of the left ventricle are now used. The objective of this research is to validate new sequences of ultrasound processing estimating the CRT. These tools are based on usual echocardiographic examination of patients

Detailed Description
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Pilot study for testing tools pre and post-treatment images echocardiography but also MRI with a descriptive purpose and identification of the computed parameters should be secondarily test a large multicenter cohort . Patients in the study will be explored in RICART preimplantation as then in the manner used in current clinical routine. The use of data by cons will focus on the study of new tools ever compared in the same patients. Data echocardiography (as with other techniques) are those used in clinical routine. Then, the data processing to be carried characterized the asynchrony posteriori, regardless of initial clinical data on a dedicated search software. Each quantitative parameter will be compared with others in order to predict the response to resynchronization. Response prediction of threshold values to the resynchronization can be obtained and compared to each of the tools. The value of relative and an addition to another may be tested. The predictive value of the change (delta) of each parameter between the pre- and post-implantation to predict response to al resynchronization, will be evaluated.

Official Title
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Revisit the Value of Imaging in Best Using CArdiac Resynchronization Therapy

Conditions
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Cardiac Resynchronization Therapy

Intervention / Treatment
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* Other: Echographic evaluation of heart function


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Any patient with sinus rhythm sent to hospital for a cardiac resynchronization according to ESC criteria and implanted with a left ventricular pacing lead quadrupole Exclusion Criteria: Patients with an acoustic window is incompatible with the accurate echographic assessment of heart function Patients with spontaneous one year prognosis is not dependent on his heart or another disease to the forefront (eg neoplasia) Contra-indications to MRI (pacemaker or implantable defibrillator, intracranial ferromagnetic surgical clips, cochlear implants, intraocular metallic foreign body, Starr-Edwards heart valve prosthesis pre 6000, biomedical device type pump insulin or neurostimulator) or against -indications to iodinated contrast injection (severe renal impairment, allergy). Patient not giving free and informed consent.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Echocardiographic evaluation<br>Echocardiographic evaluation of heart function with new processing tools | Other: Echographic evaluation of heart function<br>* Echocardiographic data collection and analysis, not fully exploited at present<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Measuring the prognostic value of a package of new ultrasonic signal processing tools | To evaluate the prognostic value of a package of new tools quantitatively measuring mechanical dyssynchrony prior to implantation of a resynchronization pacemaker in terms of favorable response at 6 months. | pre-implantation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Compare pre and post-implantation asynchrony characterisation | pre and within three day post implantation mechanical asynchrony by package of new tools will be compared with the same characterization of biventricular pacemaker. | pre-implantation, and within three day post implantation | 
| Characterization of the pre-implantation mechanical asynchrony by package of new tools | The characterization of the pre-implantation mechanical asynchrony with the package of tested tools will be correlated with the results of: Replacement fibrosis mark (taking gadolinium) and interstitial fibrosis (T1 mapping) [MRI] Evaluation of the coronary venous system by chest CT | pre-implantation | 
| Analysis and comparison of cardiac mechanical asynchrony characterization tools with other asynchronism criteria already describe | cardiac mechanical asynchrony characterization tools will be analyzed and compared, associated with other asynchronism criteria already described defined by the reverse LV remodeling 6 months post-implantation (positive response regressions = ≥15% of tele-systolic volumes VG 6 months) to define the best or the best combination of predictive tools of the response to the CRT) | at 6 month | 
| Prediction score | definition of a prediction score of the answer to the CRT (echocardiographic and multi-modality) | at 6 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Left ventricular dysfunction, Other cardiac dysrhythmias