Cardiac Magnetic Resonance Imaging After Cardiac Resynchronization Therapy

Study Overview
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Brief Summary
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This study is evaluating how MRI after CRT can provide key insights regarding LV function, structure, and mechanics resulting from CRT in patients with or without LV scar and inform optimal pacing strategies. The expected accurate and reproducible response assessment with cardiac MRI has important implications for evaluating CRT outcomes in clinical trials, and the insights from the post-CRT MRI promise to improve implementation of CRT.

Detailed Description
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We are performing a study of 40 patients with current accepted indications for CRT and no MRI contraindications. These patients will have a pre-CRT MRI and another post-CRT MRI 6 months after the CRT procedure. Echocardiography, cardiopulmonary exercise testing, symptom assessment, and laboratory testing are also performed before and after CRT. Modifications to the post-CRT MRI protocol include the use of gradient echo cine imaging rather than steady state free precession imaging, application of wideband imaging to the LGE acquisitions, and strain imaging with cine Displacement Encoding with Stimulated Echoes (DENSE) tailored for device patients.

Official Title
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Cardiac Magnetic Resonance Imaging After Cardiac Resynchronization Therapy

Conditions
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Heart Failure, Systolic

Intervention / Treatment
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* Other: MRI


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Chronic systolic HF LVEF 35% or less Guideline-based class I or IIa indication for CRT 25 and 85 years old Predominantly in sinus rhythm GFR ≥ 40 ml/min/1.73m2* *Contrast will not be given for the 6-month follow-up scan if the GFR falls to < 40 ml/min/1.73m2. Exclusion Criteria: Inability to provide informed consent Pregnancy Presence of metal embedded in the body due to prior accident or injury, as documented by skull films or other imaging Preexisting pacemaker or defibrillator prior to enrollment Cerebral aneurysm clips; 6) cochlear implants Other metallic implants (prior to enrollment) known to be contraindications to MRI Severe claustrophobia Acute kidney injury Acute renal failure or chronic kidney disease with GFR < 40 cc/min Liver transplant Gadolinium allergy

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 85 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: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Post-CRT MRI<br>This study has a single arm. Enrolled patients will follow the protocol as described, including evaluation with MRI, echocardiography, and cardiopulmonary exercise testing. | Other: MRI<br>* Cardiac MRI<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| CRT Response | CRT Response | 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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heart failure, magnetic resonance imaging, cardiac resynchronization therapy, implantable cardioverter defibrillator