Abstract
BackgroundCardiac 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.MethodsThree-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%.ResultsA 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.ConclusionThis in silico CRT simulation method is a feasible technique to screen for CRT non-responders in patients with HF and LBBB.
Highlights
Cardiac resynchronization therapy (CRT) is one of the established treatment options for patients with heart failure (HF) and left ventricular (LV) dyssynchrony [1]
We propose a patient-specific cardiac electromechanical model of pre- and post-CRT treatment to screen for CRT non-responders in patients with HF and left bundle branch block (LBBB)
The patient-specific CRT model was constructed from the computed tomography (CT) images of the patient
Summary
Cardiac resynchronization therapy (CRT) is one of the established treatment options for patients with heart failure (HF) and left ventricular (LV) dyssynchrony [1]. For achieving a more ubiquitous performance of CRT in patients with HF, patient-specific simulation methods for screening CRT non-responders need to be established. Computer simulation of cardiac electrophysiology and mechanics has been considered a useful tool for the investigation of the pathophysiology of heart disease and for the development of novel therapeutic clinical techniques [4]. We propose a patient-specific cardiac electromechanical model of pre- and post-CRT treatment to screen for CRT non-responders in patients with HF and left bundle branch block (LBBB). Cardiac resynchronization therapy (CRT) is an effective treatment option for patients with heart failure (HF) and left ventricular (LV) dyssynchrony. This study aimed to propose a novel in silico method for CRT simulation
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