Personalised Model Based Optimal Lead Guidance in Cardiac Resynchronisation Therapy

基于个性化模型的心脏再同步治疗中的最佳导联指导

• 批准号: EP/M012492/1
• 负责人: Steven Niederer
• 金额: $ 102.02万
• 依托单位: King's College London
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2015
• 资助国家: 英国
• 起止时间: 2015 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=EP%2FM012492%2F1
• 关键词: Personalised; Model; Based; Optimal; Lead

With each heart beat a wave of electrical activation sweeps across the heart stimulating the muscles to contract. In the healthy heart the wave is initiated from many locations across the wall and rapidly activates the whole heart leading to a synchronous, efficient and effective pumping of blood around the body.In patients suffering dyssynchronous heart failure the activation wave starts on the right hand side of the heart and slowly progresses to the left hand side of the heart. This asynchronous activation pattern causes an asynchronous, inefficient and ineffective pumping of blood. To treat these patients a pacing device is implanted with leads attached to the left and right hand side of the heart. By activating the left and right side of the heart from these two leads the patient's activation pattern can be resynchronised leading to a synchronous and effective contraction. This treatment is referred to as cardiac resynchronisation therapy or CRT.CRT is an effective treatment in most patients but 30-50% of patients fail to improve or respond to treatment. Due to the invasive nature and cost of the procedure it is undesirable to treat patients who will not respond. Identifying the patients who cannot respond is currently obfuscated by the inability to guarantee optimal treatment in all cases. Hence it is not possible to differentiate from patients that did not respond as they did not receive the optimal treatment from those that were unable to benefit from CRT under any conditions. At present guidelines suggest a "one size fits all" approach to the location of the leads on the patient's heart despite significant evidence that the location of the leads plays a critical role in determining outcome. This indicates that some patients may respond to CRT but only if they receive optimal lead placement.The aim of this project is to determine the best location to place the pacing lead on the left side of the heart in each individual patient receiving CRT, based on the physiology and pathology of the specific patient's heart. To achieve this aim we propose to use advanced high fidelity and resolution imaging techniques to characterise the shape of the patient's heart, the potential pacing locations, and the location of any dead non-conducting tissue in the heart. We will combine this anatomical information with measurements of electrical activation time to create a biophysical model of the electrical properties of the individual patient's heart. Using the model we will be able to simulate the activation patterns in the patient's heart for each potential pacing location. In a training data set we will compare the activation patterns at each pacing location with measured pump function, in response to pacing, to identify the activation pattern that best predicts the optimal pacing location.A prospective clinical study will then be performed where patient specific models will be created for each patient prior to procedure and the optimal pacing site identified. The predictive capacity of the model will then be evaluated when the device is implanted by testing if the model has correctly predicted the optimal pacing location. The project represents a significant advance for patient specific models - moving from a technique for analysing patient data to a tool for guiding patient treatment. Improving outcomes for CRT patients will reduce morbidity and hospitalisation rates, decrease the financial burden of non-responding patients on the NHS and improve our ability to identify what characteristics determine if a patient will respond to treatment.

每次心脏跳动时，一股电激活波扫过心脏，刺激肌肉收缩。在健康的心脏中，这种波是从跨壁的许多位置发起的，并迅速激活整个心脏，导致血液在全身同步，高效和有效地泵送。在患有非同步心力衰竭的患者中，激活波从心脏的右侧开始，慢慢地发展到心脏的左侧。这种异步激活模式导致异步、低效和无效的血液泵送。为了治疗这些病人，一个起搏装置被植入了连接在心脏左右两侧的导线。通过这两条导联激活左、右心脏，患者的激活模式可以重新同步，导致同步有效的收缩。这种治疗被称为心脏再同步治疗或CRT。CRT对大多数患者是一种有效的治疗方法，但30-50%的患者对治疗没有改善或反应。由于手术的侵入性和费用，不希望治疗没有反应的患者。目前，由于无法保证在所有病例中都能获得最佳治疗，因此无法确定哪些患者没有反应。因此，不可能区分那些没有反应的患者（因为他们没有接受最佳治疗）和那些在任何情况下都无法从CRT中受益的患者。目前的指南建议采用“一刀切”的方法来确定导联在患者心脏上的位置，尽管有大量证据表明导联的位置在决定结果方面起着关键作用。这表明一些患者可能对CRT有反应，但前提是他们接受了最佳的导线放置。该项目的目的是根据具体患者心脏的生理和病理情况，确定每个接受CRT的患者心脏左侧起搏导联的最佳位置。为了实现这一目标，我们建议使用先进的高保真度和分辨率成像技术来表征患者心脏的形状，潜在的起搏位置，以及心脏中任何死亡的非导电组织的位置。我们将把这些解剖信息与电激活时间的测量相结合，以创建个体患者心脏电特性的生物物理模型。使用该模型，我们将能够模拟患者心脏中每个潜在起搏位置的激活模式。在训练数据集中，我们将每个起搏位置的激活模式与测量的泵功能进行比较，以响应起搏，以确定最能预测最佳起搏位置的激活模式。然后进行一项前瞻性临床研究，在手术前为每位患者创建特定的模型并确定最佳起搏位置。当设备植入时，通过测试模型是否正确预测了最佳起搏位置来评估模型的预测能力。该项目代表了针对特定患者模型的重大进步——从分析患者数据的技术转变为指导患者治疗的工具。改善CRT患者的治疗结果将降低发病率和住院率，减少对NHS无反应患者的经济负担，并提高我们识别哪些特征决定患者是否对治疗有反应的能力。

项目成果

Comprehensive use of cardiac computed tomography to guide left ventricular lead placement in cardiac resynchronization therapy.

心脏计算机断层扫描的综合使用在心脏重新同步疗法中指导左心室铅放置。

• DOI: 10.1016/j.hrthm.2017.04.041
• 发表时间: 2017-09
• 期刊: Heart rhythm
• 影响因子: 5.5
• 作者: Behar JM;Rajani R;Pourmorteza A;Preston R;Razeghi O;Niederer S;Adhya S;Claridge S;Jackson T;Sieniewicz B;Gould J;Carr-White G;Razavi R;McVeigh E;Rinaldi CA
• 通讯作者: Rinaldi CA

Anatomically accurate high resolution modeling of human whole heart electromechanics: A strongly scalable algebraic multigrid solver method for nonlinear deformation.

• DOI: 10.1016/j.jcp.2015.10.045
• 发表时间: 2016-01-15
• 期刊: Journal of computational physics
• 影响因子: 4.1
• 作者: Augustin CM;Neic A;Liebmann M;Prassl AJ;Niederer SA;Haase G;Plank G
• 通讯作者: Plank G

Functional Imaging and Modeling of the Heart - 11th International Conference, FIMH 2021, Stanford, CA, USA, June 21-25, 2021, Proceedings

心脏功能成像和建模 - 第 11 届国际会议，FIMH 2021，美国加利福尼亚州斯坦福，2021 年 6 月 21-25 日，会议记录

• DOI: 10.1007/978-3-030-78710-3_60
• 发表时间: 2021
• 作者: Beach M