Document Detail

Towards a personalized and dynamic CRT-D. A computational cardiovascular model dedicated to therapy optimization.
MedLine Citation:
PMID:  23154647     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In spite of cardiac resynchronization therapy (CRT) benefits, 25-30% of patients are still non responders. One of the possible reasons could be the non optimal atrioventricular (AV) and interventricular (VV) intervals settings. Our aim was to exploit a numerical model of cardiovascular system for AV and VV intervals optimization in CRT.
METHODS: A numerical model of the cardiovascular system CRT-dedicated was previously developed. Echocardiographic parameters, Systemic aortic pressure and ECG were collected in 20 consecutive patients before and after CRT. Patient data were simulated by the model that was used to optimize and set into the device the intervals at the baseline and at the follow up. The optimal AV and VV intervals were chosen to optimize the simulated selected variable/s on the base of both echocardiographic and electrocardiographic parameters.
RESULTS: Intervals were different for each patient and in most cases, they changed at follow up. The model can well reproduce clinical data as verified with Bland Altman analysis and T-test (p > 0.05). Left ventricular remodeling was 38.7% and left ventricular ejection fraction increasing was 11% against the 15% and 6% reported in literature, respectively.
CONCLUSIONS: The developed numerical model could reproduce patients conditions at the baseline and at the follow up including the CRT effects. The model could be used to optimize AV and VV intervals at the baseline and at the follow up realizing a personalized and dynamic CRT. A patient tailored CRT could improve patients outcome in comparison to literature data.
A Di Molfetta; L Santini; G B Forleo; V Minni; K Mafhouz; D G Della Rocca; L Fresiello; F Romeo; G Ferrari
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Publication Detail:
Type:  Journal Article     Date:  2012-11-16
Journal Detail:
Title:  Methods of information in medicine     Volume:  51     ISSN:  0026-1270     ISO Abbreviation:  Methods Inf Med     Publication Date:  2012  
Date Detail:
Created Date:  2012-12-05     Completed Date:  2013-12-13     Revised Date:  2014-06-20    
Medline Journal Info:
Nlm Unique ID:  0210453     Medline TA:  Methods Inf Med     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  495-506     Citation Subset:  IM    
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MeSH Terms
Cardiac Resynchronization Therapy* / standards
Image Processing, Computer-Assisted*
Models, Cardiovascular*
Models, Statistical
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