Tissue characterization using cardiac magnetic resonance imaging and response to cardiac resynchronization therapy

Aims Cardiac magnetic resonance (CMR) imaging for tissue characterization offers valuable insights for risk stratification among patients with cardiomyopathy. This study aimed to assess the prognostic value of CMR-based tissue characterization in predicting response to cardiac resynchronization therapy (CRT) in patients with non-ischaemic cardiomyopathy (NICM). Methods and results Retrospective analysis was performed on CMR data from NICM patients before CRT implantation. Various CMR parameters, including the late gadolinium enhancement (LGE), native T1, T2, and extracellular volume (ECV), were analysed. Among the 101 patients (mean age: 66 years, male: 52.5%), 72 (71.3%) were CRT responders. The CRT responders had lower LGE burden (13.1 vs. 35.3%, P < 0.001), native T1 (1334.5 vs. 1371.6 ms, P = 0.012), T2 (42.2 vs. 45.7 ms, P < 0.001), and ECV (30.8 vs. 36.8%, P < 0.001) compared with CRT non-responders. After adjusting for other risk factors, LGE burden <= 20% [odds ratio (OR): 22.61, 95% confidence interval (CI): 4.73-176.68, P < 0.001], ECV <= 34% (OR: 15.93, 95% CI: 3.01-115.13, P = 0.002), and T2 <= 45 ms (OR: 8.10, 95% CI: 1.82-43.75, P = 0.008) were identified as predictors of good CRT response and favourable clinical outcomes (log-rank P < 0.001). Conclusion Cardiac magnetic resonance-based tissue parameters effectively predict CRT response and clinical outcomes in patients with NICM, independently of conventional predictors.