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Non-invasive simulated electrical and measured mechanical indices predict response to cardiac resynchronization therapy

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Article number104872
JournalComputers in Biology and Medicine
Volume138
DOIs
PublishedNov 2021

Bibliographical note

Funding Information: A Lee is funded by NIHR, J.Behar received research funding from Biosense Webster, J Gould is funded from Rosetrees Trust/Abbott. B Porter, M Elliott and V Mehta are funded by Abbott. CA Rinaldi receives research fees from Abbott/Medtronic/Boston Scientific/MicroPort.This work was supported by Wellcome Trust (grant no. WT 203148/Z/16/Z) and Kings Health Partners London National Institute for Health Research (NIHR) Biomedical Research Centre. Funding Information: A Lee is funded by NIHR , J.Behar received research funding from Biosense Webster , J Gould is funded from Rosetrees Trust /Abbott. B Porter, M Elliott and V Mehta are funded by Abbott . CA Rinaldi receives research fees from Abbott / Medtronic / Boston Scientific /MicroPort. Funding Information: This work was supported by Wellcome Trust (grant no. WT 203148/Z/16/Z ) and Kings Health Partners London National Institute for Health Research (NIHR) Biomedical Research Centre . Publisher Copyright: © 2021 Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

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Abstract

Background: Cardiac Resynchronization Therapy (CRT) in dyssynchronous heart failure patients is ineffective in 20–30% of cases. Sub-optimal left ventricular (LV) pacing location can lead to non-response, thus there is interest in LV lead location optimization. Invasive acute haemodynamic response (AHR) measurements have been used to optimize the LV pacing location during CRT implantation. In this manuscript, we aim to predict the optimal lead location (AHR>10%) with non-invasive computed tomography (CT) based measures of cardiac anatomical and mechanical properties, and simulated electrical activation times. Methods: Non-invasive measurements from CT images and ECG were acquired from 34 patients indicated for CRT upgrade. The LV lead was implanted and AHR was measured at different pacing sites. Computer models of the ventricles were used to simulate the electrical activation of the heart, track the mechanical motion throughout the cardiac cycle and measure the wall thickness of the LV on a patient specific basis. Results: We tested the ability of electrical, mechanical and anatomical indices to predict the optimal LV location. Electrical (RV-LV delay) and mechanical (time to peak contraction) indices were correlated with an improved AHR, while wall thickness was not predictive. A logistic regression model combining RV-LV delay and time to peak contraction was able to predict positive response with 70 ± 11% accuracy and AUROC curve of 0.73. Conclusion: Non-invasive electrical and mechanical indices can predict optimal epicardial lead location. Prospective analysis of these indices could allow clinicians to test the AHR at fewer pacing sites and reduce time, costs and risks to patients.

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