Patient-specific heart simulation can identify non-responders to cardiac resynchronization therapy

Autor: Takashi Iwamura, Seiryo Sugiura, Akihiro Isotani, Masahiro Watanabe, Takumi Washio, Kazunori Yoneda, Jun-ichi Okada, Kenji Ando, Toshiaki Hisada
Rok vydání: 2020
Předmět:
Male
Patient-Specific Modeling
medicine.medical_specialty
medicine.medical_treatment
Clinical Decision-Making
030303 biophysics
Cardiac resynchronization therapy
030204 cardiovascular system & hematology
Risk Assessment
Ventricular Function
Left
Decision Support Techniques
Cardiac Resynchronization Therapy
03 medical and health sciences
0302 clinical medicine
Risk Factors
Bi-ventricular pacing
Internal medicine
medicine
Humans
Treatment Failure
Lead (electronics)
Excitation Contraction Coupling
Aged
Aged
80 and over
Heart Failure
Non-responders
0303 health sciences
business.industry
Patient Selection
Patient-specific heart model
Models
Cardiovascular
Recovery of Function
Middle Aged
Vascular surgery
Patient specific
medicine.disease
Myocardial Contraction
Cardiac surgery
Non responders
Heart failure
cardiovascular system
Ventricular Function
Right
Ventricular pressure
Cardiology
Female
Original Article
Cardiology and Cardiovascular Medicine
business
dP/dtmax
Zdroj: Heart and Vessels
ISSN: 1615-2573
0910-8327
DOI: 10.1007/s00380-020-01577-1
Popis: To identify non-responders to cardiac resynchronization therapy (CRT), various biomarkers have been proposed, but these attempts have not been successful to date. We tested the clinical applicability of computer simulation of CRT for the identification of non-responders. We used the multi-scale heart simulator “UT-Heart,” which can reproduce the electrophysiology and mechanics of the heart based on a molecular model of the excitation–contraction mechanism. Patient-specific heart models were created for eight heart failure patients who were treated with CRT, based on the clinical data recorded before treatment. Using these heart models, bi-ventricular pacing simulations were performed at multiple pacing sites adopted in clinical practice. Improvement in pumping function measured by the relative change of maximum positive derivative of left ventricular pressure (%ΔdP/dtmax) was compared with the clinical outcome. The operators of the simulation were blinded to the clinical outcome. In six patients, the relative reduction in end-systolic volume exceeded 15% in the follow-up echocardiogram at 3 months (responders) and the remaining two patients were judged as non-responders. The simulated %ΔdP/dtmax at the best lead position could identify responders and non-responders successfully. With further refinement of the model, patient-specific simulation could be a useful tool for identifying non-responders to CRT.
Databáze: OpenAIRE
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