title: Optimizing cardiac resynchronization therapy to minimize ATP consumption heterogeneity throughout the left ventricle: a simulation analysis using a canine heart failure model.
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT) has been demonstrated to lead to 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.
  
  
  OBJECTIVE
  The purpose of this study was to demonstrate the feasibility of optimizing CRT pacing locations to achieve maximal improvement in both ATPCTHI (an ATP consumption heterogeneity index) and stroke work.
  
  
  METHODS
  We used an magnetic resonance image-based electromechanical model of the dyssynchronous heart failure (DHF) canine ventricles. ATPCTHI and stroke work improvement were determined for each of 34 CRT pacing sites evenly spaced over the LV epicardium.
  
  
  RESULTS
  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 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.
  
  
  CONCLUSIONS
  Simulation results using a canine heart failure model demonstrated that CRT can be optimized to achieve improvements in both ATPCTHI and stroke work.
authors.affiliation: Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Yuxuan
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Viatcheslav
authors.initials: V
authors.lastname: Gurev
authors.affiliation: Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jason
authors.initials: J
authors.lastname: Constantino
authors.affiliation: Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland. Electronic address: ntrayanova@jhu.edu.
authors.forename: Natalia
authors.initials: N
authors.lastname: Trayanova
mesh_terms: D000255:Adenosine Triphosphate / Q000378:metabolism*; D000818:Animals; D058406:Cardiac Resynchronization Therapy; D004195:Disease Models, Animal; D004285:Dogs; D005240:Feasibility Studies; D006333:Heart Failure / Q000378:metabolism / Q000628:therapy*; D006439:Hemodynamics; D008279:Magnetic Resonance Imaging; D013318:Stroke Volume; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D000255:Adenosine Triphosphate
keywords: Cardiac resynchronization therapy; Dyssynchronous heart failure; Heart failure; Left bundle branch block; Optimal pacing site; Reverse remodeling