scholarly journals In silico screening method for non-responders to cardiac resynchronization therapy in patients with heart failure: a pilot study

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Minki Hwang ◽  
Jae-Sun Uhm ◽  
Min Cheol Park ◽  
Eun Bo Shim ◽  
Chan Joo Lee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Simulation Model ◽  
In Silico ◽  
Clinical Observation ◽  
Three Dimensional ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Patients With Heart Failure

Abstract Background Cardiac resynchronization therapy (CRT) is an effective treatment option for patients with heart failure (HF) and left ventricular (LV) dyssynchrony. However, the problem of some patients not responding to CRT remains unresolved. This study aimed to propose a novel in silico method for CRT simulation. Methods Three-dimensional heart geometry was constructed from computed tomography images. The finite element method was used to elucidate the electric wave propagation in the heart. The electric excitation and mechanical contraction were coupled with vascular hemodynamics by the lumped parameter model. The model parameters for three-dimensional (3D) heart and vascular mechanics were estimated by matching computed variables with measured physiological parameters. CRT effects were simulated in a patient with HF and left bundle branch block (LBBB). LV end-diastolic (LVEDV) and end-systolic volumes (LVESV), LV ejection fraction (LVEF), and CRT responsiveness measured from the in silico simulation model were compared with those from clinical observation. A CRT responder was defined as absolute increase in LVEF ≥ 5% or relative increase in LVEF ≥ 15%. Results A 68-year-old female with nonischemic HF and LBBB was retrospectively included. The in silico CRT simulation modeling revealed that changes in LVEDV, LVESV, and LVEF by CRT were from 174 to 173 mL, 116 to 104 mL, and 33 to 40%, respectively. Absolute and relative ΔLVEF were 7% and 18%, respectively, signifying a CRT responder. In clinical observation, echocardiography showed that changes in LVEDV, LVESV, and LVEF by CRT were from 162 to 119 mL, 114 to 69 mL, and 29 to 42%, respectively. Absolute and relative ΔLVESV were 13% and 31%, respectively, also signifying a CRT responder. CRT responsiveness from the in silico CRT simulation model was concordant with that in the clinical observation. Conclusion This in silico CRT simulation method is a feasible technique to screen for CRT non-responders in patients with HF and LBBB.

scholarly journals Prediction of 5-year survival in patients with heart failure and implanted cardiac resynchronization therapy devices

2021 ◽  
Vol 26 (6) ◽  
pp. 4409
Author(s):  
A. M. Soldatova ◽  
V. A. Kuznetsov ◽  
E. A. Gorbatenko ◽  
T. N. Enina ◽  
L. M. Malishevsky
Keyword(s):  
Heart Failure ◽  
Survival Rate ◽  
Cardiac Resynchronization Therapy ◽  
Nyha Class ◽  
Training Sample ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Patients With Heart Failure

Aim. Based on clinical parameters and diagnostic investigations, to create a complex model of personalized selection of patients with heart failure (HF) for cardiac resynchronization therapy (CRT). To establish the diagnostic value of the created model in predicting 5-year survival.Material and methods. The study included 141 patients with HF (men, 77,3%; women, 22,7%). The mean age of patients at the time of implantation was 60,0 [53,0; 66,0] years. All patients had New York Heart Association (NYHA) class II-IV HF, left ventricular ejection fraction (LVEF) ≤35%, and QRS ≥130 ms. Patients were randomly divided into training (n=95) and test (n=36) samples, which were comparable in main clinical and functional characteristics.Results. The index included parameters that had a significant relationship with 5-year survival according to the Cox regression: male sex, prior myocardial infarction, hypertension, QRS <150 ms, no left bundle branch block, PR ≥200 ms with sinus rhythm/absence of radiofrequency ablation in atrial fibrillation, NYHA class III, IV HF, LVEF <30%, left ventricular end-diastolic volume ≥235,0 ml, NT-proBNP ≥2692,0 ng/ml. All variables were scored based on the в-coefficients. In the training sample, a value ≥45 points demonstrated a sensitivity of 82,4% and a specificity of 67,2% in predicting 5-year survival (AUC, 0,873; p<0,001). The index use on the test sample showed comparable results (AUC, 0,718; p=0,020; sensitivity — 71,4%, specificity — 62,5%). Also, in the training sample, the index ≥45 points was associated with1-year survival (sensitivity — 84,6%, specificity — 58,1%, AUC, 0,811; p<0,001).Conclusion. An index of personalized selection for CRT has been created, which makes it possible to accurately predict the 5-year survival rate, as well as the 1-year survival rate, regardless of the current selection criteria.

Cardiac resynchronization therapy: Selection of candidates

2021 ◽  
pp. 577-586
Author(s):  
Victoria Delgado ◽  
Jens-Uwe Voigt
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Multimodality Imaging ◽  
Treatment Guideline ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Patients With Heart Failure ◽  
Left Ventricular Mechanics ◽  
Selection Of

Cardiac resynchronization therapy (CRT) is an established therapy for patients with heart failure who remain symptomatic despite optimal medical treatment. Guideline recommendations for patient selection have been published by all major scientific societies including the ESC and are regularly updated. Unfortunately, the rate of patients who do not respond to CRT remains stable in the range of 30–40%, even in indication class I. In the selection of patients with heart failure who may benefit from cardiac resynchronization therapy (CRT), evaluation of left ventricular mechanics and dyssynchrony, extent, and location of myocardial scar and cardiac venous anatomy are most important. Multimodality imaging is pivotal to obtain this information and understand how CRT exerts its effects. This chapter will review the current state-of-the-art of multimodality imaging to select patients for CRT implantation.

Cardiac resynchronization therapy for patients with atrial fibrillation

2011 ◽  
Vol 152 (44) ◽  
pp. 1757-1763
Author(s):  
Attila Mihálcz ◽  
Pál Ábrahám ◽  
Attila Kardos ◽  
Csaba Földesi ◽  
Tamás Szili-Török
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Rate Control ◽  
Randomized Trials ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Patients With Heart Failure

Atrial fibrillation and chronic heart failure are two major and even growing cardiovascular conditions that often coexist. Cardiac resynchronization therapy is an important, device-based, non-pharmacological approach in a selected group of chronic heart failure patients that has been shown to improve left ventricular function and to reduce both morbidity and mortality in large randomized trials. The latest European and American guidelines have considered atrial fibrillation patients with heart failure eligible for cardiac resynchronization therapy. This review summarizes current literature concerning the following topics: prognostic relevance of atrial fibrillation in heart failure, effects of cardiac resynchronization therapy in atrial fibrillation, relevance and strategies of rhythm and rate control in this group of patients. Authors explain how atrial fibrillation may interfere with the delivery of adequate cardiac resynchronization therapy, how to reduce the burden of atrial tachyarrhythmias, and finally present a brief overview. Orv. Hetil., 2011, 152, 1757–1763.

scholarly journals LOCALIZATION OF THE LEFT VENTRICULAR MYOCARDIAL SCARRING AND ITS ELECTRICAL ACTIVATION IN PATIENTS WITH HEART FAILURE AND DIFFERENT RESPONSE TO CARDIAC RESYNCHRONIZATION THERAPY

2020 ◽  
Vol 26 (3) ◽  
pp. 5-14
Author(s):  
M. D. Utsumueva ◽  
N. A. Mironova ◽  
O. V. Stukalova ◽  
E. M. Gupalo ◽  
S. Yu. Kashtanova ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Patients With Heart Failure ◽  
Qrs Duration ◽  
Response Group ◽  
Crt Response ◽  
Device Programming

Introduction. As a significant number of patients with heart failure (HF) does not respond to cardiac resynchronization therapy (CRT), a lot of research has deservedly focused on optimization, and better patient selection. The ideal resynchronization depends on different factors, from device programming to heart features and left ventricle (LV) lead position. Analysis of the 12-lead electrocardiogram (ECG) is the most simple method which can provide important information on LV lead location, presence of scar at LV pacing site, and fusion of intrinsic activation or RV pacing with LV pacing.Purpose. To analyze the electrophysiological and structural heart features and their correlation with the ECG pattern during biventricular (BV) pacing in patients with HF and CRT devices.Methods. The study included 47 patients (mean age 62.3±8.9 years) with LBBB, QRS duration ≥ 130 ms, left ventricular ejection fraction (LVEF) ≤ 35%, heart failure (HF) NYHA II-IV despite optimal pharmacological therapy during months. All patients had undergone CRT-D implantation. Late-gadolinium enhancement-cardiovascular magnetic resonance (LGE-CMR), 12-lead ECG, non-invasive cardiac mapping (NICM) (with obtaining the zone of late LV activation (ZLA)) were undertaken prior to CRT devices implantation. NICM with cardiac CT and evaluation of LV lead position, ECG pattern during BV pacing (#1 - fusion complex with increased or dominant R wave, independent of QRS duration, #2- QS pattern with QRS duration normalization, and #3- QS pattern with increased QRS duration) were undertaken after CRT devices implantation. Response to CRT was estimated by echo and was defined as decrease in LV end-systolic volume by > 15% after 6 months of follow-up.Results. CRT was effective in 28 patients (59.5%). According to the results of NICM, zone of late LV activation more often was located at 5,6,11,12 segments, and LV pacing site - at 6,7,12 segments of LV. In the “response” group overlap of scar zone and zone of late LV activation was observed (p=0.005). The presence of scar tissue in the LV pacing site was associated with CRT non-response (p<0.001), and the pacing zone of late LV activation resulted in the best CRT response (p<0.001). The distance from the LV electrode to the zone of late LV activation was less in the “CRT response” group (33 [20;42] mm vs 83 [55;100] mm, p<0.001). The most beneficial ECG pattern during BV pacing was #2, and #3 was more often observed in the group “CRT non-response”; configuration #1 was intermediate between ECG patterns #2 and #3.Conclusions. A comprehensive examination, including the study of the structural and electrophysiological heart features is important for the optimal positioning the LV lead and subsequent CRT device programming. The simple analysis of the QRS pattern during BV pacing can show whether biventricular pacing is adequately performed and can reveal inadequate CRT programming and LV lead positioning.

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