The role of cardiac magnetic resonance in identifying appropriate candidates for cardiac resynchronisation therapy – A systematic review of the literature

George Bazoukis, Jeremy Man Ho Hui, Yan Hiu Athena Lee, Oscar Hou In Chou, Dimitrios Sfairopoulos, Konstantinos Vlachos, Athanasios Saplaouras, Konstantinos P. Letsas, Michael Efremidis, Gary Tse, Vassilios S. Vassiliou, Panagiotis Korantzopoulos

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Despite the strict indications for cardiac resynchronization therapy (CRT) implantation, a significant proportion of patients will fail to adequately respond to the treatment. This systematic review aims to present the existing evidence about the role of cardiac magnetic resonance (CMR) in identifying patients who are likely to respond better to the CRT. A systematic search in the MedLine database and Cochrane Library from their inception to August 2021 was performed, without any limitations, by two independent investigators. We considered eligible observational studies or randomized clinical trials (RCTs) that enrolled patients > 18 years old with heart failure (HF) of ischaemic or non-ischaemic aetiology and provided data about the association of baseline CMR variables with clinical or echocardiographic response to CRT for at least 3 months. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA Statement). Following our search strategy, 47 studies were finally included in our review. CMR appears to have an additive role in identifying the subgroup of patients who will respond better to CRT. Specifically, the presence and the extent of myocardial scar were associated with increased non-response rates, while those with no scar respond better. Furthermore, existing data show that scar location can be associated with CRT response rates. CMR-derived markers of mechanical desynchrony can also be used as predictors of CRT response. CMR data can be used to optimize the position of the left ventricular lead during the CRT implantation procedure. Specifically, positioning the left ventricular lead in a branch of the coronary sinus that feeds an area with transmural scar was associated with poorer response to CRT. CMR can be used as a non-invasive optimization tool to identify patients who are more likely to achieve better clinical and echocardiographic response following CRT implantation.
Original languageEnglish
Pages (from-to)2095–2118
Number of pages24
JournalHeart Failure Reviews
Issue number6
Early online date31 Aug 2022
Publication statusPublished - Nov 2022


  • CRT response
  • Cardiac magnetic resonance
  • Cardiac resynchronization therapy
  • Late gadolinium enhancement
  • Myocardial fibrosis

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