Impact of Interventricular Lead Distance on Cardiac Resynchronization Therapy Outcomes.

Abstract

Cardiac resynchronization therapy (CRT) has been shown as an essential treatment of patients with heart failure, leading to improvements in symptoms, left ventricular (LV) function, and survival. However, up to 30% of appropriately selected patients remain nonresponders to CRT. The aim of our study was to test a hypothesis on the impact of lead positioning in the ventricular walls on CRT response in patients with advanced chronic heart failure with and without pre-operative inter and intraventricular myocardial dyssynchrony. We examined 53 guideline-selected CRT candidates. Response to CRT was defined in 6 months after implantation of CRT devices. All patients underwent standard and Doppler echocardiography for assessment of LV function and mechanical dyssynchrony. Individual right ventricular (RV) and LV lead tip position, inter-lead distance, and the horizontal and vertical components were measured on the radiograph images with using an automated custom made software Our results showed that the RLV inter-lead distance is an essential parameter correlated with the CRT outcomes. A logistic model comprising the RLV inter-lead distance with parameters of dyssynchrony demonstrated a high predictive power for odds of CRT success.

Machine Learning prediction of cardiac resynchronisation therapy response from combination of clinical and model-driven data

“…This was a bit surprising, as no difference in this feature was found between the responders and non-responders (see Table 3), as well as no correlation with LV EF improvement in our patient cohort (r<0.25, p>0.05). However, selection of this distance as an important feature for ML classifier is in line with clinical studies, where the LAT zone was considered as a target area for LV lead deployment [44,33,45,46]. In particular, consistent with clinical data, our results indicate that optimal electrode deployment should be guided by a kind of minimum-maximum optimization with respect to the distance from LAT and lesion areas, respectively.…”

“…Although ventricular mechanical dyssynchrony was considered with respect to CRT improvements [47,48,46,49], we did not use mechanical dyssynchrony indices in developing our classifiers because not every patient had these features indicated in the retrospective dataset. We did not find a correlation between the ML response scores generated from the selected hybrid data and the mechanical dyssynchrony indices measured in 34 patients at the baseline (r<0.25, p>0.05 for IVD, Tsmax-Tsmin, SD12).…”

Machine Learning Prediction of Cardiac Resynchronisation Therapy Response From Combination of Clinical and Model-Driven Data

“…This was a bit surprising, as no difference in this feature was found between the responders and non-responders (see Table 2 ), as well as no correlation with LV EF improvement in our patient cohort ( r < 0.25, p > 0.05). However, selection of this distance as an important feature for ML classifier is in line with clinical studies, where the LAT zone was considered as a target area for LV lead deployment (Chumarnaya et al, 2017 ; Stephansen et al, 2018 ; Zubarev et al, 2019 ; Lahiri et al, 2020 ). In particular, consistent with clinical data, our results indicate that optimal electrode deployment should be guided by a kind of minimum-maximum optimization with respect to the distances from LAT and disease-induced remodeling area, respectively.…”

“…Although ventricular mechanical dyssynchrony was considered with respect to CRT improvements (Duckett et al, 2011 ; Heydari et al, 2012 ; Stankovic et al, 2014 ; Chumarnaya et al, 2017 ), we did not use mechanical dyssynchrony indices in developing our classifiers because not every patient had these features indicated in the retrospective dataset. We did not find a correlation between the ML response scores generated from the selected hybrid data and the mechanical dyssynchrony indices measured in 34 patients at the baseline ( r < 0.25, p > 0.05 for IVD, Tsmax-Tsmin, SD12).…”

Resynchronization Therapy for Chronic Heart Failure: Diagnostic and Therapeutic Approaches

“…Объективной конечной точкой клинического эффекта считается уменьшение ФК ХСН на 1 позицию [41]. Кроме того, клиническим эффектом можно считать 10-25 % прироста расстояния, пройденного в тесте с 6-минутной ходьбой, и повышение КЖ пациентов [42]. Одним из важных эхокардиографических критериев ответа на РТ считается увеличение ФВ ЛЖ на 5 % и более [43].…”