Key result
A novel vectorcardiography-derived dyssynchrony index successfully discriminated electrical dyssynchronous patterns from ventricular synchrony in a 1,914-patient population.
Why the study?
Successful cardiac resynchronization therapy in patients with heart failure with reduced ejection fraction is limited by the lack of precise dyssynchrony quantification.
Does a vectorcardiography-derived dyssynchrony index accurately quantify ventricular electrical dyssynchrony and correlate with mechanical dyssynchrony?
Observational (n=1,914)
Does a vectorcardiography-derived dyssynchrony index accurately quantify ventricular electrical dyssynchrony and correlate with mechanical dyssynchrony?
A novel vectorcardiography-derived index from standard ECGs can accurately quantify ventricular electrical dyssynchrony and correlates with mechanical dyssynchrony, potentially improving CRT patient selection and device optimization.
May aid dyssynchrony quantification for CRT; leaves open clinical utility pending validation.
Alteration of muscle activation sequence is a key mechanism in heart failure with reduced ejection fraction. Successful cardiac resynchronization therapy (CRT), which has become standard therapy in these patients, is limited by the lack of precise dyssynchrony quantification. We implemented a computational pipeline that allows assessment of ventricular dyssynchrony by vectorcardiogram reconstruction from the patient's electrocardiogram. We defined a ventricular dyssynchrony index as the distance between the voltage and speed time integrals of an individual observation and the linear fit of these variables obtained from a healthy population. The pipeline was tested in a 1914-patient population. The dyssynchrony index showed minimum values in heathy controls and maximum values in patients with left bundle branch block (LBBB) or with a pacemaker (PM). We established a critical dyssynchrony index value that discriminates electrical dyssynchronous patterns (LBBB and PM) from ventricular synchrony. In 10 patients with PM or CRT devices, dyssynchrony indexes above the critical value were associated with high time to peak strain standard deviation, an echocardiographic measure of mechanical dyssynchrony. Our index proves to be a promising tool to evaluate ventricular activation dyssynchrony, potentially enhancing the selection of candidates for CRT, device configuration during implantation, and post-implant optimization.
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Fernández et al. (2022) conducted an observational in Ventricular dyssynchrony (n=1,914). Vectorcardiography-derived ventricular dyssynchrony index vs. Healthy controls was evaluated on Discrimination of electrical dyssynchronous patterns (LBBB and PM) from ventricular synchrony. A novel vectorcardiography-derived dyssynchrony index successfully discriminated electrical dyssynchronous patterns from ventricular synchrony in a 1,914-patient population.
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