Electrical Substrates Driving Response to Cardiac Resynchronization Therapy A Combined Clinical-Computational Evaluation
Electrical Substrates Driving Response to Cardiac Resynchronization Therapy A Combined Clinical-Computational Evaluation
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DOI：
10.1161/circep.117.005647
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发表时间：
2018-04-01
影响因子：
8.4
通讯作者：
Bordachar, Pierre
中科院分区：
文献类型：
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作者：
Huntjens, Peter R.;Ploux, Sylvain;Bordachar, Pierre
背景技术背景：室间与心室内不同步对心脏起搏治疗（CRT）反应的预测价值尚不清楚。我们研究了两个心室电基板组件左心室（LV）血流动力学function.METHODS和RESULTS的相对重要性：第一，我们使用的心血管计算模型CircAdapt的特点的孤立的影响，固有的室间和心室内激活CRT响应（Δ LVDP/dt（最大））。模拟Δ LVdP/dt（max）（范围：1.3%-26.5%）随着室间不同步的增加而显著增加。相比之下，LV或右心室中心室内不同步的孤立效应有限（Δ LVdP/dt（max）范围：分别为12.3%-18.3%和14.1%-15.7%）。双心室起搏期间激动对Δ LVdP/dt（max）的影响较小。其次，使用51名CRT候选人的心电图成像衍生激动特征在CircAdapt中个性化心室激动。随后使用个体化模型评估基于电气数据的Δ LVdP/dt（max）预测的准确性。当仅对固有室间不同步进行个性化时，模型预测的Delta LVdP/dt（max）接近左束支分支传导阻滞患者的实际值（测量-模拟：2.7 +/- 9.0%）。在无左束支分支传导阻滞的患者中，CircAdapt系统性高估了Delta LVdP/dt（max）（测量-模拟：9.2 +/- 7.1%）。增加心室内激活的模型没有提高响应prediction.CONCLUSIONS：计算机模拟显示，内在的室间不同步是主导组成部分的电基板驱动响应CRT的准确性。内在心室内不同步和双心室起搏期间的任何不同步在这方面起次要作用。这可以促进用于预测CRT响应的患者特异性建模。
BACKGROUND: The predictive value of interventricular versus intraventricular dyssynchrony for response to cardiac resynchronization therapy (CRT) remains unclear. We investigated the relative importance of both ventricular electrical substrate components for left ventricular (LV) hemodynamic function.METHODS AND RESULTS: First, we used the cardiovascular computational model CircAdapt to characterize the isolated effect of intrinsic interventricular and intraventricular activation on CRT response (Delta LVdP/dt(max)). Simulated Delta LVdP/dt(max) (range: 1.3%-26.5%) increased considerably with increasing interventricular dyssynchrony. In contrast, the isolated effect of intraventricular dyssynchrony in either the LV or right ventricle was limited (Delta LVdP/dt(max) range: 12.3%-18.3% and 14.1%-15.7%, respectively). Effects of activation during biventricular pacing on Delta LVdP/dt(max) were small. Second, electrocardiographic imaging-derived activation characteristics of 51 CRT candidates were used to personalize ventricular activation in CircAdapt. The individualized models were subsequently used to assess the accuracy of Delta LVdP/dt(max) prediction based on the electrical data. The model-predicted Delta LVdP/dt(max) was close to the actual value in patients with left bundle branch block (measured-simulated: 2.7 +/- 9.0%) when only intrinsic interventricular dyssynchrony was personalized. Among patients without left bundle branch block, Delta LVdP/dt(max) was systematically overpredicted by CircAdapt (measured-simulated: 9.2 +/- 7.1%). Adding intraventricular activation to the model did not improve the accuracy of the response prediction.CONCLUSIONS: Computer simulations revealed that intrinsic interventricular dyssynchrony is the dominant component of the electrical substrate driving the response to CRT. Intrinsic intraventricular dyssynchrony and any dyssynchrony during biventricular pacing play a minor role in this respect. This may facilitate patient-specific modeling for prediction of CRT response.