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Europace. 2016 Dec;18(suppl 4):iv104-iv112. doi: 10.1093/europace/euw356.

Non-invasive, model-based measures of ventricular electrical dyssynchrony for predicting CRT outcomes.

Author information

  • 1Department of Bioengineering, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA 92093-0412, USA.
  • 2Department of Medicine (Cardiology), University of California, 9500 Gilman Drive, La Jolla, San Diego, CA 92093-0613, USA.
  • 3US Department of Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
  • 4Department of Bioengineering, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA 92093-0412, USA amcculloch@ucsd.edu.

Abstract

AIMS:

Left ventricular activation delay due to left bundle branch block (LBBB) is an important determinant of the severity of dyssynchronous heart failure (DHF). We investigated whether patient-specific computational models constructed from non-invasive measurements can provide measures of baseline dyssynchrony and its reduction after CRT that may explain the degree of long-term reverse ventricular remodelling.

METHODS AND RESULTS:

LV end-systolic volume reduction (ΔESVLV) measured by 2D trans-thoracic echocardiography in eight patients following 6 months of CRT was significantly (P < 0.05) greater in responders (26 ± 20%, n = 4) than non-responders (11 ± 16%, n = 4). LV reverse remodelling did not correlate with baseline QRS duration or its change after biventricular pacing, but did correlate with baseline LV endocardial activation measured by electroanatomic mapping (R2 =0.71, P < 0.01). Patient-specific models of LBBB ventricular activation with parameters obtained by matching model-computed vectorcardiograms (VCG) to those derived from standard patient ECGs yielded LV endocardial activation times that correlated well with those measured from endocardial maps (R2 =0.90). Model-computed 3D LV activation times correlated strongly with the reduction in LVESV (R2 =0.93, P < 0.001). Computed decreases due to simulated CRT in the time delay between LV septal and lateral activation correlated strongly with ΔESVLV (R2 =0.92, P < 0.001). Models also suggested that optimizing VV delays may improve resynchronization by this measure of activation delay.

CONCLUSIONS:

Patient-specific computational models constructed from non-invasive measurements can compute estimates of LV dyssynchrony and their changes after CRT that may be as good as or better than electroanatomic mapping for predicting long-term reverse remodelling.

KEYWORDS:

Cardiac resynchronization therapy; Computational modelling; Electroanatomic mapping; Heart failure; Left bundle branch block; Vectorcardiogram

PMID:
28011837
PMCID:
PMC5225967
[Available on 2017-12-01]
DOI:
10.1093/europace/euw356
[PubMed - in process]
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