Non-invasive, model-based measures of ventricular electrical dyssynchrony for predicting CRT outcomes

作者：Villongco Christopher T; Krummen David E; Omens Jeffrey H; McCulloch Andrew D

来源：Europace, 2016, 18(suppl_4): 104-112.

DOI：10.1093/europace/euw356

• Heart failure
• Left bundle branch block
• Cardiac resynchronization therapy
• Computational modelling
• Vectorcardiogram
• Electroanatomic mapping

Aims Left ventricular activation delay due to left bundle branch block (LBBB) is an important determinant of the severity of dyssynchronous heart failure (DHF). We investigated whether patient-specific computational models constructed from non-invasive measurements can provide measures of baseline dyssynchrony and its reduction after CRT that may explain the degree of long-term reverse ventricular remodelling.
Methods and results LV end-systolic volume reduction (Delta ESVLV) measured by 2D trans-thoracic echocardiography in eight patients following 6 months of CRT was significantly (P<0.05) greater in responders (26 +/- 20%, n = 4) than non-responders (11 +/- 16%, n = 4). LV reverse remodelling did not correlate with baseline QRS duration or its change after biventricular pacing, but did correlate with baseline LV endocardial activation measured by electroanatomic mapping (R-2 = 0.71, P < 0.01). Patient-specific models of LBBB ventricular activation with parameters obtained by matching model-computed vectorcardiograms (VCG) to those derived from standard patient ECGs yielded LV endocardial activation times that correlated well with those measured from endocardial maps (R-2 = 0.90). Model-computed 3D LV activation times correlated strongly with the reduction in LVESV (R-2 = 0.93, P < 0.001). Computed decreases due to simulated CRT in the time delay between LV septal and lateral activation correlated strongly with Delta ESVLV (R-2 = 0.92, P < 0.001). Models also suggested that optimizing VV delays may improve resynchronization by this measure of activation delay.
Conclusions Patient-specific computational models constructed from non-invasive measurements can compute estimates of LV dyssynchrony and their changes after CRT that may be as good as or better than electroanatomic mapping for predicting long-term reverse remodelling.

• 出版日期2016-12