Multi-scale, tailor-made heart simulation can predict the effect of cardiac resynchronization therapy
Multi-scale, tailor-made heart simulation can predict the effect of cardiac resynchronization therapy
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DOI：
10.1016/j.yjmcc.2017.05.006
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发表时间：
2017-07-01
影响因子：
5
通讯作者：
Sugiura, Seiryo
中科院分区：
文献类型：
--
作者：
Okada, Jun-ichi;Washio, Takumi;Sugiura, Seiryo
背景：目前提出的识别从心脏再同步化治疗（CRT）中获益的患者的标准仍然需要优化。一种能够再现跳动心脏的电生理和力学的多尺度心脏模拟可能有助于解决这个问题。本回顾性研究的目的是通过应用最新的多尺度心脏模拟技术，测试患者特异性模拟模型重现CRT反应的能力。方法与结果：根据9例经双心室起搏治疗的心力衰竭并传导阻滞患者治疗前的临床资料，建立具有真实三维形态的患者特异性心脏模型。每个模型都是量身定制的，以类似于临床实践中使用的格式再现每个患者的表面心电图和血液动力学，包括心电图（ECG）、超声心动图和血液动力学测量。然后根据实际起搏方案对各心脏模型进行CRT模拟，并与临床数据进行比较。CRT模拟改善了每位患者的ECG指数并减少了壁运动不同步。然而，这些结果与实际反应并不相关。心室压时间导数最大值（dP/dt(max)）与临床观察到的射血分数（EF）改善之间的相关性最好（r = 0.94, p < 0.01）。结论：通过整合心脏复杂的病理生理，患者特异性的、多尺度的心脏模拟可以成功地再现对CRT的反应。经过进一步验证，该技术可作为临床决策的有用工具。(C) 2017年作者。Elsevier Ltd.出版。
Background: The currently proposed criteria for identifying patients who would benefit from cardiac resynchronization therapy (CRT) still need to be optimized. A multi-scale heart simulation capable of reproducing the electrophysiology and mechanics of a beating heart may help resolve this problem. The objective of this retrospective study was to test the capability of patient-specific simulation models to reproduce the response to CRT by applying the latest multi-scale heart simulation technology.Methods and results: We created patient-specific heart models with realistic three-dimensional morphology based on the clinical data recorded before treatment in nine patients with heart failure and conduction block treated by biventricular pacing. Each model was tailored to reproduce the surface electrocardiogram and hemo-dynamics of each patient in formats similar to those used in clinical practice, including electrocardiography (ECG), echocardiography, and hemodynamic measurements. We then performed CRT simulation on each heart model according to the actual pacing protocol and compared the results with the clinical data. CRT simulation improved the ECG index and diminished wall motion dyssynchrony in each patient. These results, however, did not correlate with the actual response. The best correlation was obtained between the maximum value of the time derivative of ventricular pressure (dP/dt(max)) and the clinically observed improvement in the ejection fraction (EF) (r = 0.94, p < 0.01).Conclusions: By integrating the complex pathophysiology of the heart, patient-specific, multi-scale heart simulation could successfully reproduce the response to CRT. With further verification, this technique could be a useful tool in clinical decision making. (C) 2017 The Authors. Published by Elsevier Ltd.