Department of Biomedical Engineering, CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Universiteitssingel 40, 6200 MD, The Netherlands.
Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.
Europace. 2023 Dec 28;26(1). doi: 10.1093/europace/euae009.
Identifying heart failure (HF) patients who will benefit from cardiac resynchronization therapy (CRT) remains challenging. We evaluated whether virtual pacing in a digital twin (DT) of the patient's heart could be used to predict the degree of left ventricular (LV) reverse remodelling post-CRT.
Forty-five HF patients with wide QRS complex (≥130 ms) and reduced LV ejection fraction (≤35%) receiving CRT were retrospectively enrolled. Echocardiography was performed before (baseline) and 6 months after CRT implantation to obtain LV volumes and 18-segment longitudinal strain. A previously developed algorithm was used to generate 45 DTs by personalizing the CircAdapt model to each patient's baseline measurements. From each DT, baseline septal-to-lateral myocardial work difference (MWLW-S,DT) and maximum rate of LV systolic pressure rise (dP/dtmax,DT) were derived. Biventricular pacing was then simulated using patient-specific atrioventricular delay and lead location. Virtual pacing-induced changes ΔMWLW-S,DT and ΔdP/dtmax,DT were correlated with real-world LV end-systolic volume change at 6-month follow-up (ΔLVESV). The DT's baseline MWLW-S,DT and virtual pacing-induced ΔMWLW-S,DT were both significantly associated with the real patient's reverse remodelling ΔLVESV (r = -0.60, P < 0.001 and r = 0.62, P < 0.001, respectively), while correlation between ΔdP/dtmax,DT and ΔLVESV was considerably weaker (r = -0.34, P = 0.02).
Our results suggest that the reduction of septal-to-lateral work imbalance by virtual pacing in the DT can predict real-world post-CRT LV reverse remodelling. This DT approach could prove to be an additional tool in selecting HF patients for CRT and has the potential to provide valuable insights in optimization of CRT delivery.
识别将从心脏再同步治疗（CRT）中获益的心力衰竭（HF）患者仍然具有挑战性。我们评估了患者心脏数字孪生体（DT）中的虚拟起搏是否可用于预测 CRT 后左心室（LV）反向重构的程度。
回顾性纳入 45 例 QRS 波群宽度≥130 ms 且 LV 射血分数≤35%的 HF 患者接受 CRT。在 CRT 植入前（基线）和植入后 6 个月进行超声心动图检查，以获得 LV 容积和 18 节段纵向应变。使用先前开发的算法通过将 CircAdapt 模型个性化为每位患者的基线测量值来生成 45 个 DT。从每个 DT 中得出基线间隔到侧壁心肌工作差（MWLW-S，DT）和 LV 收缩压最大上升率（dP/dtmax，DT）。然后使用患者特定的房室延迟和导联位置模拟双心室起搏。虚拟起搏引起的变化 ΔMWLW-S，DT 和 ΔdP/dtmax，DT 与 6 个月随访时的真实 LV 末期容积变化（ΔLVESV）相关。DT 的基线 MWLW-S，DT 和虚拟起搏引起的 ΔMWLW-S，DT 均与真实患者的反向重构 ΔLVESV 显著相关（r = -0.60，P < 0.001 和 r = 0.62，P < 0.001），而 ΔdP/dtmax，DT 和 ΔLVESV 之间的相关性则较弱（r = -0.34，P = 0.02）。
我们的结果表明，DT 中虚拟起搏引起的间隔到侧壁工作失衡的减少可以预测 CRT 后真实的 LV 反向重构。这种 DT 方法可能成为 CRT 选择 HF 患者的另一种工具，并有可能为 CRT 提供有价值的见解。
Zotero 插件
