Regional Left Ventricular Fiber Stress Analysis for Cardiac Resynchronization Therapy Response
Mohammad Albatat1,2, Henrik Nicolay Finsberg3, Hermenegild Arevalo3
1Intervention Centre, Oslo University Hospital, Oslo, Norway. malbatat.90@gmail.com.
Insights
A new measure, standard deviation of regional wall stress at mitral valve closure (SD_MVC), can predict heart failure patient response to cardiac resynchronization therapy (CRT). Lower SD_MVC indicates better CRT response, potentially improving patient selection.
Area of Science:
- Cardiology
- Biomedical Engineering
- Computational Modeling
Background:
- Cardiac resynchronization therapy (CRT) benefits select heart failure (HF) patients.
- High non-response rates (over 30%) persist due to suboptimal patient selection and optimization.
- Novel methods are needed to accurately predict CRT response.
Purpose of the Study:
- To evaluate a novel computational measure for assessing CRT response in heart failure patients.
- To investigate the correlation between regional left ventricular wall stress and CRT outcomes.
- To identify improved pre-procedural criteria for CRT patient selection.
Main Methods:
- Utilized a computational modeling framework to calculate regional left ventricular wall stress.
- Measured the standard deviation of regional wall stress at mitral valve closure (SD_MVC) in seven CRT patients and seven healthy controls.
- Compared SD_MVC between groups and correlated it with long-term CRT response (end-diastolic volume reduction).
Main Results:
- SD_MVC was significantly lower in healthy controls compared to CRT patients.
- Lower SD_MVC values correlated with better long-term CRT response in patients.
- The single non-responder exhibited the highest SD_MVC, suggesting its predictive value.
Conclusions:
- SD_MVC is a promising novel metric for predicting CRT response in heart failure patients.
- This measure may enhance current patient selection criteria for CRT implantation.
- Further validation in larger patient cohorts is warranted.
Abstract:
Cardiac resynchronization therapy (CRT) is an effective treatment for a subgroup of heart failure (HF) patients, but more than 30% of those selected do not improve after CRT implantation. Imperfect pre-procedural criteria for patient selection and optimization are the main causes of the high non-response rate. In this study, we evaluated a novel measure for assessing CRT response. We used a computational modeling framework to calculate the regional stress of the left ventricular wall of seven CRT patients and seven healthy controls. The standard deviation of regional wall stress at the time of mitral valve closure (SD_MVC) was used to quantify dyssynchrony and compared between patients and controls and among the patients. The results show that SD_MVC is significantly lower in controls than patients and correlates with long-term response in patients, based on end-diastolic volume reduction. In contrast to our initial hypothesis, patients with lower SD_MVC respond better to therapy. The patient with the highest SD_MVC was the only non-responder in the patient cohort. The distribution of fiber stress at the beginning of the isovolumetric phase seems to correlate with the degree of response and the use of this measurement could potentially improve selection criteria for CRT implantation. Further studies with a larger cohort of patients are needed to validate these results.
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