Key result
Computational modeling accurately reproduces patient-specific electromechanical delay and strain patterns in typical LBBB.
Why the study?
The objective was to propose a computational-model-based interpretation of the different patterns of LV contraction observed in LBBB with preserved contractility or myocardial scarring.
Can a patient-specific computational model simulate the electromechanical delay and specific contractility patterns in patients with left bundle branch block?
Can a patient-specific computational model simulate the electromechanical delay and specific contractility patterns in patients with left bundle branch block?
A personalized computational model can accurately reproduce patient-specific left ventricular electromechanical dynamics and local scar effects in LBBB, offering a potential tool for optimizing cardiac resynchronization therapy planning.
Patient-specific LBBB models may guide future CRT planning; leaves open clinical utility pending prospective validation.
Left bundle branch block (LBBB) is associated with specific septal-to-lateral wall activation patterns which are strongly influenced by the intrinsic left ventricular (LV) contractility and myocardial scar localization. The objective of this study was to propose a computational-model-based interpretation of the different patterns of LV contraction observed in the case of LBBB and preserved contractility or myocardial scarring. Two-dimensional transthoracic echocardiography was used to obtain LV volumes and deformation patterns in three patients with LBBB: (1) a patient with non-ischemic dilated cardiomyopathy, (2) a patient with antero-septal myocardial scar, and (3) a patient with lateral myocardial scar. Scar was confirmed by the distribution of late gadolinium enhancement with cardiac magnetic resonance imaging (cMRI). Model parameters were evaluated manually to reproduce patient-derived data such as strain curves obtained from echocardiographic apical views. The model was able to reproduce the specific strain patterns observed in patients. A typical septal flash with pre-ejection shortening, rebound stretch, and delayed lateral wall activation was observed in the case of non-ischemic cardiomyopathy. In the case of lateral scar, the contractility of the lateral wall was significantly impaired and septal flash was absent. In the case of septal scar, septal flash and rebound stretch were also present as previously described in the literature. Interestingly, the model was also able to simulate the specific contractile properties of the myocardium, providing an excellent localization of LV scar in ischemic patients. The model was able to simulate the electromechanical delay and specific contractility patterns observed in patients with LBBB of ischemic and non-ischemic etiology. With further improvement and validation, this technique might be a useful tool for the diagnosis and treatment planning of heart failure patients needing CRT.
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Owashi et al. (2022) studied Left bundle branch block (n=3). Computational modeling was evaluated on Reproduction of patient-specific strain patterns. The computational model successfully simulated the specific electromechanical delay, contractility patterns, and myocardial scar localization observed in patients with typical left bundle branch block.
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