Int J Arrhythm.  2022 Mar;23(1):2. 10.1186/s42444-021-00052-w.

In silico screening method for non‑responders to cardiac resynchronization therapy in patients with heart failure: a pilot study

  • 1AI Medic Inc., Seoul, Republic of Korea
  • 2Department of Cardiology, Yongin Severance Hospital, Yonsei University College of Medicine, 363 Dongbae‑ kjukjeon‑daero, Giheung‑gu, Yongin‑si, Gyeonggi‑do 16995, Republic of Korea
  • 3Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, Gangwon‑do, Republic of Korea
  • 4Division of Cardiol‑ ogy, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea


Cardiac resynchronization therapy (CRT) is an effective treatment option for patients with heart failure (HF) and left ventricular (LV) dyssynchrony. However, the problem of some patients not responding to CRT remains unresolved. This study aimed to propose a novel in silico method for CRT simulation.
Three-dimensional heart geometry was constructed from computed tomography images. The finite ele‑ ment method was used to elucidate the electric wave propagation in the heart. The electric excitation and mechani‑ cal contraction were coupled with vascular hemodynamics by the lumped parameter model. The model parameters for three-dimensional (3D) heart and vascular mechanics were estimated by matching computed variables with measured physiological parameters. CRT effects were simulated in a patient with HF and left bundle branch block (LBBB). LV end-diastolic (LVEDV) and end-systolic volumes (LVESV), LV ejection fraction (LVEF), and CRT responsiveness measured from the in silico simulation model were compared with those from clinical observation. A CRT responder was defined as absolute increase in LVEF ≥ 5% or relative increase in LVEF ≥ 15%.
A 68-year-old female with nonischemic HF and LBBB was retrospectively included. The in silico CRT simu‑ lation modeling revealed that changes in LVEDV, LVESV, and LVEF by CRT were from 174 to 173 mL, 116 to 104 mL, and 33 to 40%, respectively. Absolute and relative ΔLVEF were 7% and 18%, respectively, signifying a CRT responder. In clinical observation, echocardiography showed that changes in LVEDV, LVESV, and LVEF by CRT were from 162 to 119 mL, 114 to 69 mL, and 29 to 42%, respectively. Absolute and relative ΔLVESV were 13% and 31%, respectively, also signifying a CRT responder. CRT responsiveness from the in silico CRT simulation model was concordant with that in the clinical observation.
This in silico CRT simulation method is a feasible technique to screen for CRT non-responders in patients with HF and LBBB.


Cardiac resynchronization therapy; In silico modeling; Non-responder; Virtual CRT
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