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A rapid electromechanical model to predict reverse remodeling following cardiac resynchronization therapy

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Abstract

Cardiac resynchronization therapy (CRT) is an effective therapy for patients who suffer from heart failure and ventricular dyssynchrony such as left bundle branch block (LBBB). When it works, it reverses adverse left ventricular (LV) remodeling and the progression of heart failure. However, CRT response rate is currently as low as 50–65%. In theory, CRT outcome could be improved by allowing clinicians to tailor the therapy through patient-specific lead locations, timing, and/or pacing protocol. However, this also presents a dilemma: there are far too many possible strategies to test during the implantation surgery. Computational models could address this dilemma by predicting remodeling outcomes for each patient before the surgery takes place. Therefore, the goal of this study was to develop a rapid computational model to predict reverse LV remodeling following CRT. We adapted our recently developed computational model of LV remodeling to simulate the mechanics of ventricular dyssynchrony and added a rapid electrical model to predict electrical activation timing. The model was calibrated to quantitatively match changes in hemodynamics and global and local LV wall mass from a canine study of LBBB and CRT. The calibrated model was used to investigate the influence of LV lead location and ischemia on CRT remodeling outcome. Our model results suggest that remodeling outcome varies with both lead location and ischemia location, and does not always correlate with short-term improvement in QRS duration. The results and time frame required to customize and run this model suggest promise for this approach in a clinical setting.

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Acknowledgements

This study was funded by the National Institutes of Health (U01 HL127654) and the Seraph Foundation.

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Authors and Affiliations

  1. Department of Biomedical Engineering, University of Virginia, Box 800759, Health System, Charlottesville, VA, 22903, USA

    Pim J. A. Oomen & Jeffrey W. Holmes

  2. Department of Medicine, University of Virginia, Box 800158, Health System, Charlottesville, VA, 22903, USA

    Pim J. A. Oomen & Kenneth C. Bilchick

  3. Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115, USA

    Thien-Khoi N. Phung

  4. Department of Biomedical Engineering, The Ohio State University, 140 W 19th Ave Columbus, Columbus, OH, 43210, USA

    Seth H. Weinberg

  5. School of Engineering, University of Alabama at Birmingham, 1075 13th St S, Birmingham, AL, 35233, USA

    Jeffrey W. Holmes

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Oomen, P.J.A., Phung, TK.N., Weinberg, S.H. et al. A rapid electromechanical model to predict reverse remodeling following cardiac resynchronization therapy. Biomech Model Mechanobiol 21, 231–247 (2022). https://doi.org/10.1007/s10237-021-01532-7

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