title: The relative role of patient physiology and device optimisation in cardiac resynchronisation therapy: A computational modelling study.
abstract: Cardiac resynchronisation therapy (CRT) is an established treatment for heart failure, however the effective selection of patients and optimisation of therapy remain controversial. While extensive research is ongoing, it remains unclear whether improvements in patient selection or therapy planning offers a greater opportunity for the improvement of clinical outcomes. This computational study investigates the impact of both physiological conditions that guide patient selection and the optimisation of pacing lead placement on CRT outcomes. A multi-scale biophysical model of cardiac electromechanics was developed and personalised to patient data in three patients. These models were separated into components representing cardiac anatomy, pacing lead location, myocardial conductivity and stiffness, afterload, active contraction and conduction block for each individual, and recombined to generate a cohort of 648 virtual patients. The effect of these components on the change in total activation time of the ventricles (ΔTAT) and acute haemodynamic response (AHR) was analysed. The pacing site location was found to have the largest effect on ΔTAT and AHR. Secondary effects on ΔTAT and AHR were found for functional conduction block and cardiac anatomy. The simulation results highlight a need for a greater emphasis on therapy optimisation in order to achieve the best outcomes for patients.
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom; Institute of Biophysics, Medical University of Graz, Austria.
authors.forename: Andrew
authors.initials: A
authors.lastname: Crozier
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom.
authors.forename: Bojan
authors.initials: B
authors.lastname: Blazevic
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom.
authors.forename: Pablo
authors.initials: P
authors.lastname: Lamata
authors.affiliation: Institute of Biophysics, Medical University of Graz, Austria.
authors.forename: Gernot
authors.initials: G
authors.lastname: Plank
authors.affiliation: Department of Cardiology, Guy's and St. Thomas' Hospital, London, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Ginks
authors.affiliation: Department of Cardiology, Guy's and St. Thomas' Hospital, London, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Duckett
authors.affiliation: Department of Cardiology, Guy's and St. Thomas' Hospital, London, United Kingdom.
authors.forename: Manav
authors.initials: M
authors.lastname: Sohal
authors.affiliation: Department of Cardiology, Guy's and St. Thomas' Hospital, London, United Kingdom.
authors.forename: Anoop
authors.initials: A
authors.lastname: Shetty
authors.affiliation: Department of Cardiology, Guy's and St. Thomas' Hospital, London, United Kingdom.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Rinaldi
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom.
authors.forename: Reza
authors.initials: R
authors.lastname: Razavi
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom; Faculty of Engineering, University of Auckland, New Zealand.
authors.forename: Nicolas P
authors.initials: NP
authors.lastname: Smith
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom. Electronic address: steven.niederer@kcl.ac.uk.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Niederer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy; D003198:Computer Simulation; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D009206:Myocardium / Q000378:metabolism; D018754:Ventricular Dysfunction
keywords: Cardiac resynchronisation therapy; Computational modelling; Dyssynchronous heart failure; Heart failure; Patient-specific modelling