Prediction of Cardiac Resynchronization Therapy Response Using a Lead Placement Score Derived From 4-Dimensional Computed Tomography
| Autor: | Ashish Manohar, Gabrielle M. Colvert, James Yang, Zhennong Chen, Maria J. Ledesma-Carbayo, Mads Brix Kronborg, Anders Sommer, Bjarne L. Nørgaard, Jens Cosedis Nielsen, Elliot R. McVeigh |
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| Rok vydání: | 2022 |
| Předmět: |
Heart Failure
Lipopolysaccharides Clinical Trials as Topic Ventricular Function Left Cardiac Resynchronization Therapy Heart Failure/diagnostic imaging Treatment Outcome Humans Radiology Nuclear Medicine and imaging Prospective Studies Cardiology and Cardiovascular Medicine Tomography Retrospective Studies |
| Zdroj: | Manohar, A, Colvert, G M, Yang, J, Chen, Z, Ledesma-Carbayo, M J, Kronborg, M B, Sommer, A, Nørgaard, B L, Nielsen, J C & McVeigh, E R 2022, ' Prediction of Cardiac Resynchronization Therapy Response Using a Lead Placement Score Derived From 4-Dimensional Computed Tomography ', Circulation. Cardiovascular Imaging (Online), vol. 15, no. 8, e014165 . https://doi.org/10.1161/CIRCIMAGING.122.014165 |
| ISSN: | 1942-0080 1941-9651 |
| DOI: | 10.1161/circimaging.122.014165 |
| Popis: | Background: Cardiac resynchronization therapy (CRT) is an effective treatment for patients with heart failure; however, 30% of patients do not respond to the treatment. We sought to derive patient-specific left ventricle maps of lead placement scores (LPS) that highlight target pacing lead sites for achieving a higher probability of CRT response. Methods: Eighty-two subjects recruited for the ImagingCRT trial (Empiric Versus Imaging Guided Left Ventricular Lead Placement in Cardiac Resynchronization Therapy) were retrospectively analyzed. All 82 subjects had 2 contrast-enhanced full cardiac cycle 4-dimensional computed tomography scans: a baseline and a 6-month follow-up scan. CRT response was defined as a reduction in computed tomography–derived end-systolic volume ≥15%. Eight left ventricle features derived from the baseline scans were used to train a support vector machine via a bagging approach. An LPS map over the left ventricle was created for each subject as a linear combination of the support vector machine feature weights and the subject’s own feature vector. Performance for distinguishing responders was performed on the original 82 subjects. Results: Fifty-two (63%) subjects were responders. Subjects with an LPS≤Q 1 (lower-quartile) had a posttest probability of responding of 14% (3/21), while subjects with an LPS≥ Q 3 (upper-quartile) had a posttest probability of responding of 90% (19/21). Subjects with Q 1 3 had a posttest probability of responding that was essentially unchanged from the pretest probability (75% versus 63%, P =0.2). An LPS threshold that maximized the geometric mean of true-negative and true-positive rates identified 26/30 of the nonresponders. The area under the curve of the receiver operating characteristic curve for identifying responders with an LPS threshold was 87%. Conclusions: An LPS map was defined using 4-dimensional computed tomography–derived features of left ventricular mechanics. The LPS correlated with CRT response, reclassifying 25% of the subjects into low probability of response, 25% into high probability of response, and 50% unchanged. These encouraging results highlight the potential utility of 4-dimensional computed tomography in guiding patient selection for CRT. The present findings need verification in larger independent data sets and prospective trials. |
| Databáze: | OpenAIRE |
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