Optimizing cardiac resynchronization therapy to minimize ATP consumption heterogeneity throughout the left ventricle: a simulation analysis using a canine heart failure model.
Optimizing cardiac resynchronization therapy to minimize ATP consumption heterogeneity throughout the left ventricle: a simulation analysis using a canine heart failure model.
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DOI：
10.1016/j.hrthm.2014.03.021
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发表时间：
2014-06
期刊：
影响因子：
5.5
通讯作者：
Trayanova, Natalia
中科院分区：
文献类型：
--
作者：
Hu, Yuxuan;Gurev, Viatcheslav;Constantino, Jason;Trayanova, Natalia
关键词：
心脏再同步治疗（CRT）已被证明可以恢复整个左心室（LV）耗氧量的均匀性，这对于心室的长期反向重塑非常重要。然而，研究主要集中在确定导致血流动力学急剧改善的左心室起搏部位。目前尚不清楚是否存在左心室起搏位点，既可以改善血流动力学，又可以使整个左心室的 ATP 消耗均匀，从而最大限度地提高 CRT 的短期和长期效益。我们的目的是证明优化 CRT 起搏位置以最大程度地改善 ATPCTHI（ATP 消耗异质性指数）和每搏功的可行性。我们采用了基于 MRI 的犬心室不同步衰竭 (DHF) 机电模型。 ATPCTHI 和每搏功改善情况均针对 LV 心外膜上均匀分布的 34 个 CRT 起搏点进行测定。结果证明了确定最佳左心室起搏部位的可行性，该起搏部位可同时最大程度地改善 ATPCTHI 和每搏功。 DHF 犬心室中最佳 LV CRT 起搏部位位于心尖部和基部之间的中间位置。与每搏功的改善相比，ATPCTHI 的改善随着距最佳部位的距离而下降得更快。来自最佳部位的 CRT 通过增加间隔 ATP 消耗并减少侧壁 ATP 消耗来均匀化 ATP 消耗。使用犬心力衰竭模型的模拟结果表明，可以优化 CRT 以实现 ATPCTHI 和中风功的改善。
Cardiac resynchronization therapy (CRT) has been demonstrated to lead to the restoration of oxygen consumption homogeneity throughout the left ventricle (LV), which is important for long-term reverse remodeling of the ventricles. However, research has focused exclusively on identifying the LV pacing sites that led to acute hemodynamic improvements. It remains unclear whether there exist LV pacing sites that could both improve the hemodynamics and result in ATP consumption homogeneity throughout the LV, thus maximizing both CRT short-term and long-term benefits. We aimed to demonstrate the feasibility of optimizing CRT pacing locations to achieve maximal improvement in both ATPCTHI (an ATP consumption heterogeneity index) and stroke work. We employed an MRI-based electromechanical model of the dyssynchronous failing (DHF) canine ventricles. ATPCTHI and stroke work improvement were determined for each of 34 CRT pacing sites evenly spaced over the LV epicardium. Results demonstrated the feasibility of determining the optimal LV pacing site that achieves simultaneous maximum improvements in ATPCTHI and stroke work. The optimal LV CRT pacing sites in the DHF canine ventricles were located midway between apex and base. The improvement in ATPCTHI decreased more rapidly with the distance from the optimal sites as compared to stroke work improvement. CRT from the optimal sites homogenized ATP consumption by increasing septal ATP consumption and decreasing that of the lateral wall. Simulation results using a canine heart failure model demonstrated that CRT can be optimized to achieve improvements in both ATPCTHI and stroke work.
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