Patient-specific electromechanical models of the heart for the prediction of pacing acute effects in CRT: A preliminary clinical validation

We present the personalisation of a 3D electromechanical model of the heart to predict the acute haemodynamic changes associated with CRT. The acute effects of pacing were predicted with the model for several pacing con- ditions on two patients, achieving good agreement with invasive haemody- namic measurements. These promising results demonstrate the potential of biophysical models to improve patient selection and plan CRT. [Display omitted] ► Personalisation of an electromechanical model integrating anatomy, electrophysiology, kinematics and mechanics. ► Quantitative evaluation of the different personalisation steps. ► Prediction of the pressure curves for different pacing conditions. ► Quantitative validation of the predictions from interventional measurements. Cardiac resynchronisation therapy (CRT) is an effective treatment for patients with congestive heart failure and a wide QRS complex. However, up to 30% of patients are non-responders to therapy in terms of exercise capacity or left ventricular reverse remodelling. A number of controversies still remain surrounding patient selection, targeted lead implantation and optimisation of this important treatment. The development of biophysical models to predict the response to CRT represents a potential strategy to address these issues. In this article, we present how the personalisation of an electromechanical model of the myocardium can predict the acute haemodynamic changes associated with CRT. In order to introduce such an approach as a clinical application, we needed to design models that can be individualised from images and electrophysiological mapping of the left ventricle. In this paper the personalisation of the anatomy, the electrophysiology, the kinematics and the mechanics are described. The acute effects of pacing on pressure development were predicted with the in silico model for several pacing conditions on two patients, achieving good agreement with invasive haemodynamic measurements: the mean error on dP/dtmax is 47.5±35mmHgs−1, less than 5% error. These promising results demonstrate the potential of physiological models personalised from images and electrophysiology signals to improve patient selection and plan CRT.