Prediction of Cardiac Resynchronization Therapy Response Using a Lead Placement Score Derived From 4-Dimensional Computed Tomography

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • Ashish Manohar, University of California at San Diego
  • ,
  • Gabrielle M Colvert, University of California at San Diego
  • ,
  • James Yang, University of California at San Diego
  • ,
  • Zhennong Chen, University of California at San Diego
  • ,
  • Maria J Ledesma-Carbayo, Universidad Politécnica de Madrid, Biomaterials and Nanomedicine (CIBER-BBN)
  • ,
  • Mads Brix Kronborg
  • Anders Sommer
  • ,
  • Bjarne L Nørgaard
  • Jens Cosedis Nielsen
  • Elliot R McVeigh, University of California at San Diego

BACKGROUND: Cardiac resynchronization therapy (CRT) is an effective treatment for patients with heart failure; however, 30% of patients do not respond to the treatment. We sought to derive patient-specific left ventricle maps of lead placement scores (LPS) that highlight target pacing lead sites for achieving a higher probability of CRT response.

METHODS: Eighty-two subjects recruited for the ImagingCRT trial (Empiric Versus Imaging Guided Left Ventricular Lead Placement in Cardiac Resynchronization Therapy) were retrospectively analyzed. All 82 subjects had 2 contrast-enhanced full cardiac cycle 4-dimensional computed tomography scans: a baseline and a 6-month follow-up scan. CRT response was defined as a reduction in computed tomography-derived end-systolic volume ≥15%. Eight left ventricle features derived from the baseline scans were used to train a support vector machine via a bagging approach. An LPS map over the left ventricle was created for each subject as a linear combination of the support vector machine feature weights and the subject's own feature vector. Performance for distinguishing responders was performed on the original 82 subjects.

RESULTS: Fifty-two (63%) subjects were responders. Subjects with an LPS≤Q1 (lower-quartile) had a posttest probability of responding of 14% (3/21), while subjects with an LPS≥ Q3 (upper-quartile) had a posttest probability of responding of 90% (19/21). Subjects with Q1<LPS<Q3 had a posttest probability of responding that was essentially unchanged from the pretest probability (75% versus 63%, P=0.2). An LPS threshold that maximized the geometric mean of true-negative and true-positive rates identified 26/30 of the nonresponders. The area under the curve of the receiver operating characteristic curve for identifying responders with an LPS threshold was 87%.

CONCLUSIONS: An LPS map was defined using 4-dimensional computed tomography-derived features of left ventricular mechanics. The LPS correlated with CRT response, reclassifying 25% of the subjects into low probability of response, 25% into high probability of response, and 50% unchanged. These encouraging results highlight the potential utility of 4-dimensional computed tomography in guiding patient selection for CRT. The present findings need verification in larger independent data sets and prospective trials.

Original languageEnglish
Article numbere014165
JournalCirculation. Cardiovascular Imaging (Online)
Volume15
Issue8
ISSN1942-0080
DOIs
Publication statusPublished - Aug 2022

    Research areas

  • Cardiac Resynchronization Therapy, Clinical Trials as Topic, Heart Failure/diagnostic imaging, Humans, Lipopolysaccharides, Prospective Studies, Retrospective Studies, Tomography, Treatment Outcome, Ventricular Function, Left

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