Multi-scale, tailor-made heart simulation can predict the effect of cardiac resynchronization therapy
Jun-Ichi Okada1, Takumi Washio1, Machiko Nakagawa2
1Department of Human and Engineered Environmental Studies, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa-shi, Chiba 277-0871, Japan.
Journal of Molecular and Cellular Cardiology
|May 16, 2017
Summary
Patient-specific heart simulations show promise for predicting cardiac resynchronization therapy (CRT) response. While simulations improved ECG and reduced dyssynchrony, correlating with clinical outcomes requires further refinement, particularly with ejection fraction improvements.
Area of Science:
- Computational cardiology
- Biomedical engineering
- Medical simulation
Background:
- Current criteria for identifying patients who would benefit from cardiac resynchronization therapy (CRT) require optimization.
- Multi-scale heart simulation models offer a potential solution for predicting CRT response by integrating electrophysiology and mechanics.
- Patient-specific simulation technology can aid in resolving challenges in CRT patient selection.
Purpose of the Study:
- To test the capability of patient-specific simulation models to reproduce the response to CRT.
- To apply the latest multi-scale heart simulation technology in a retrospective study.
- To evaluate the accuracy of simulation in predicting clinical outcomes after CRT.
Main Methods:
- Created patient-specific heart models using clinical data from nine heart failure patients.
- Tailored models to reproduce pre-treatment electrocardiogram (ECG) and hemodynamics.
- Performed CRT simulations and compared results with clinical data, including ECG, echocardiography, and hemodynamic measurements.
Main Results:
- CRT simulation improved ECG index and reduced wall motion dyssynchrony in all simulated patients.
- Simulated improvements did not directly correlate with actual clinical response in all cases.
- Maximum time derivative of ventricular pressure (dP/dtmax) showed the strongest correlation (r=0.94, p<0.01) with observed ejection fraction improvement.
Conclusions:
- Patient-specific, multi-scale heart simulation can reproduce CRT response by integrating complex cardiac pathophysiology.
- This simulation technique holds potential as a valuable tool for clinical decision-making in CRT.
- Further verification is needed to fully establish the clinical utility of this advanced simulation technology.
