title: Tailor-made heart simulation predicts the effect of cardiac resynchronization therapy in a canine model of heart failure.
abstract: Despite extensive studies on clinical indices for the selection of patient candidates for cardiac resynchronization therapy (CRT), approximately 30% of selected patients do not respond to this therapy. Herein, we examined whether CRT simulations based on individualized realistic three-dimensional heart models can predict the therapeutic effect of CRT in a canine model of heart failure with left bundle branch block. In four canine models of failing heart with dyssynchrony, individualized three-dimensional heart models reproducing the electromechanical activity of each animal were created based on the computer tomographic images. CRT simulations were performed for 25 patterns of three ventricular pacing lead positions. Lead positions producing the best and the worst therapeutic effects were selected in each model. The validity of predictions was tested in acute experiments in which hearts were paced from the sites identified by simulations. We found significant correlations between the experimentally observed improvement in ejection fraction (EF) and the predicted improvements in ejection fraction (P<0.01) or the maximum value of the derivative of left ventricular pressure (P<0.01). The optimal lead positions produced better outcomes compared with the worst positioning in all dogs studied, although there were significant variations in responses. Variations in ventricular wall thickness among the dogs may have contributed to these responses. Thus CRT simulations using the individualized three-dimensional heart models can predict acute hemodynamic improvement, and help determine the optimal positions of the pacing lead.
authors.affiliation: Department of Cardiac Surgery, School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 Japan.
authors.forename: Nirmal
authors.initials: N
authors.lastname: Panthee
authors.affiliation: Department of Human and Engineered Environmental Studies, Graduate School of Frontier Sciences, The University of Tokyo, 178-4-4 Wakashiba, Kashiwa, Chiba, 277-0871 Japan; UT-Heart Inc. 3-25-8 Nozawa, Setagaya-ku, Tokyo 154-0003 Japan.
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Okada
authors.affiliation: Department of Human and Engineered Environmental Studies, Graduate School of Frontier Sciences, The University of Tokyo, 178-4-4 Wakashiba, Kashiwa, Chiba, 277-0871 Japan; UT-Heart Inc. 3-25-8 Nozawa, Setagaya-ku, Tokyo 154-0003 Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Washio
authors.affiliation: Laboratory of Veterinary Internal Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonancho, Musashino-shi, Tokyo 180-8602 Japan.
authors.forename: Youhei
authors.initials: Y
authors.lastname: Mochizuki
authors.affiliation: Laboratory of Veterinary Internal Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonancho, Musashino-shi, Tokyo 180-8602 Japan.
authors.forename: Ryohei
authors.initials: R
authors.lastname: Suzuki
authors.affiliation: Laboratory of Veterinary Internal Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonancho, Musashino-shi, Tokyo 180-8602 Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Koyama
authors.affiliation: Department of Cardiac Surgery, School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Ono
authors.affiliation: Department of Human and Engineered Environmental Studies, Graduate School of Frontier Sciences, The University of Tokyo, 178-4-4 Wakashiba, Kashiwa, Chiba, 277-0871 Japan; UT-Heart Inc. 3-25-8 Nozawa, Setagaya-ku, Tokyo 154-0003 Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Hisada
authors.affiliation: Department of Human and Engineered Environmental Studies, Graduate School of Frontier Sciences, The University of Tokyo, 178-4-4 Wakashiba, Kashiwa, Chiba, 277-0871 Japan; UT-Heart Inc. 3-25-8 Nozawa, Setagaya-ku, Tokyo 154-0003 Japan. Electronic address: sugiura@k.u-tokyo.ac.jp.
authors.forename: Seiryo
authors.initials: S
authors.lastname: Sugiura
mesh_terms: D000818:Animals; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D003198:Computer Simulation; D004285:Dogs; D006321:Heart / Q000503:physiopathology*; D006333:Heart Failure / Q000503:physiopathology* / Q000628:therapy*; D006352:Heart Ventricles / Q000503:physiopathology; D008297:Male; D008955:Models, Cardiovascular; D066230:Patient-Specific Modeling; D011379:Prognosis; D013813:Therapy, Computer-Assisted; D016896:Treatment Outcome
keywords: Heart block; Heart failure; Multi-scale simulation; Pacemakers