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

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

doi:10.1093/europace/euw356

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

Europace. 2016 Dec;18(suppl 4):iv104-iv112. doi: 10.1093/europace/euw356.

Authors

Christopher T Villongco^{1

2}, David E Krummen^{2

3}, Jeffrey H Omens^{1

2}, Andrew D McCulloch^{4

2}

Affiliations

¹ Department of Bioengineering, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA 92093-0412, USA.
² Department of Medicine (Cardiology), University of California, 9500 Gilman Drive, La Jolla, San Diego, CA 92093-0613, USA.
³ US Department of Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
⁴ Department of Bioengineering, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA 92093-0412, USA amcculloch@ucsd.edu.

Abstract

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 (ΔESV_LV) 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 (R²=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 (R²=0.90). Model-computed 3D LV activation times correlated strongly with the reduction in LVESV (R²=0.93, P < 0.001). Computed decreases due to simulated CRT in the time delay between LV septal and lateral activation correlated strongly with ΔESV_LV (R²=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.

Keywords: Cardiac resynchronization therapy; Computational modelling; Electroanatomic mapping; Heart failure; Left bundle branch block; Vectorcardiogram.

MeSH terms

Action Potentials
Aged
Bundle-Branch Block / diagnosis
Bundle-Branch Block / physiopathology
Bundle-Branch Block / therapy*
Cardiac Resynchronization Therapy / methods*
Electrocardiography
Electrophysiologic Techniques, Cardiac
Heart Failure / diagnosis
Heart Failure / physiopathology
Heart Failure / therapy*
Heart Rate
Humans
Male
Middle Aged
Models, Cardiovascular*
Patient-Specific Modeling*
Predictive Value of Tests
Recovery of Function
Signal Processing, Computer-Assisted
Stroke Volume
Time Factors
Treatment Outcome
Vectorcardiography
Ventricular Dysfunction, Left / diagnosis
Ventricular Dysfunction, Left / physiopathology
Ventricular Dysfunction, Left / therapy*
Ventricular Function, Left*
Ventricular Remodeling

Abstract

MeSH terms

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