Document Detail


Length-dependent tension in the failing heart and the efficacy of cardiac resynchronization therapy.
MedLine Citation:
PMID:  20952413     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Cardiac resynchronization therapy (CRT) has emerged as one of the few effective and safe treatments for heart failure. However, identifying patients that will benefit from CRT remains controversial. The dependence of CRT efficacy on organ and cellular scale mechanisms was investigated in a patient-specific computer model to identify novel patient selection criteria.
METHODS AND RESULTS: A biophysically based patient-specific coupled electromechanics heart model has been developed which links the cellular and sub-cellular mechanisms which regulate cardiac function to the whole organ function observed clinically before and after CRT. A sensitivity analysis of the model identified lack of length dependence of tension regulation within the sarcomere as a significant contributor to the efficacy of CRT. Further simulation analysis demonstrated that in the whole heart, length-dependent tension development is key not only for the beat-to-beat regulation of stroke volume (Frank-Starling mechanism), but also the homogenization of tension development and strain.
CONCLUSIONS: In individuals with effective Frank-Starling mechanism, the length dependence of tension facilitates the homogenization of stress and strain. This can result in synchronous contraction despite asynchronous electrical activation. In these individuals, synchronizing electrical activation through CRT may have minimal benefit.
Authors:
Steven A Niederer; Gernot Plank; Phani Chinchapatnam; Matthew Ginks; Pablo Lamata; Kawal S Rhode; Christopher A Rinaldi; Reza Razavi; Nicolas P Smith
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-10-14
Journal Detail:
Title:  Cardiovascular research     Volume:  89     ISSN:  1755-3245     ISO Abbreviation:  Cardiovasc. Res.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-13     Completed Date:  2011-04-22     Revised Date:  2014-03-25    
Medline Journal Info:
Nlm Unique ID:  0077427     Medline TA:  Cardiovasc Res     Country:  England    
Other Details:
Languages:  eng     Pagination:  336-43     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Biomechanical Phenomena
Cardiac Resynchronization Therapy*
Computer Simulation
Electrocardiography
Excitation Contraction Coupling*
Female
Heart Conduction System / physiopathology*
Heart Failure / diagnosis,  physiopathology,  therapy*
Humans
Magnetic Resonance Imaging, Cine
Middle Aged
Models, Cardiovascular*
Patient Selection
Reproducibility of Results
Sarcomeres / pathology
Stroke Volume
Treatment Outcome
Ventricular Function, Left*
Grant Support
ID/Acronym/Agency:
F 3210-N18//Austrian Science Fund FWF

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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