Statistical ranking of electromechanical dyssynchrony parameters for CRT

Abstract

ObjectiveMechanical evaluation of dyssynchrony by echocardiography has not replaced ECG in routine cardiac resynchronisation therapy (CRT) evaluation because of its complexity and lack of reproducibility. The objective of this study was to evaluate the potential correlations between electromechanical parameters (atrioventricular, interventricular and intraventricular from the dyssynchrony model presented in 2000), their ability to describe dyssynchrony and their potential use in resynchrony.Methods455 sets of the 18 parameters of the model obtained in 91 patients submitted to various pacing configurations were evaluated two by two using a Pearson correlation test and then by groups according to their ability to describe dyssynchrony, using the Column selection method of machine learning.ResultsThe best parameter is duration of septal contraction, which alone describes 25% of dyssynchrony. The best groups of 3, 4 and ≥8 variables describe 59%, 73% and almost 100% of dyssynchrony, respectively. Left pre-ejection interval is highly and significantly correlated to a maximum of other variables, and its decrease is associated with the favourable evolution of all other correlated parameters. Increase in filling duration and decrease in duration of septum to lateral wall contraction difference are not associated with the favourable evolution of other parameters.ConclusionsNo single electromechanical parameter alone can fully describe dyssynchrony. The 18-parameter model can be simplified, but still requires at least 4–8 parameters. Decrease in left pre-ejection interval favourably drives resynchrony in a maximum of other parameters. Increase in filling duration and decrease in septum–lateral wall difference do not appear to be good CRT targets.

Acute correction of electromechanical dyssynchrony and response to cardiac resynchronization therapy

“…that LPEI was the one correlated with the greatest number of other parameters, 13 out of 17. 18 A decrease of LPEI was associated with directionally similar changes of the other parameters indicating improved synchrony. We found that a 16 ms decrease in LPEI was the optimal cut-off for predicting CRT response at 6 months.…”

Personal-by-Design: A 3D Electromechanical Model of the Heart Tailored for Personalisation

“…Moreover, we performed a sensivity analysis (Table 1) on the mechanical model using a Latin Hypercube Sampling method, coupled with the computation of the Partial Ranked Correlation Coefficient [9] for a collection of relevant model outputs, selected from [2].…”