Ventricular geometry –regularized QRSd predicts cardiac resynchronization therapy response: machine learning from crosstalk between electrocardiography and echocardiography

AbstractUp to one-third of patients selected by current guidelines do not respond to cardiac resynchronization therapy (CRT), the aim of this study was to find out novel analytical approaches to improve pre-implantation CRT response prediction. Among 31 pre-implantation features of clinical, laboratory, electrocardiography (ECG), and echocardiography variables in a consecutive cohort of patients receiving a first-time CRT device(CRT-pacemaker or CRT-defibrillator), we developed a machine learning (ML) model with three classification algorithms (support vector machines (SVM),K nearest neighbors, and random subspaces) with the best features combination to predict CRT response. Three categorical variables, left bundle branch block (LBBB), nonischemic cardiomyopathy, and female gender, were independently associated with CRT responses. Among continuous variables, including septal wall thickness, posterior wall thickness, and relative wall thickness (RWT), could regularize ECG QRS duration (QRSd) and significantly enhance the correlation between QRSd and CRT response. The 3 ML algorithms in a total of 38 features combinations constantly recognized that the features combined with QRSd/RWT outperformed the combinations without it. For each of three algorithms, the triplet feature combination of QRSd/RWT, LBBB, and nonischemic cardiomyopathy repeatedly increased the classification rate more than 8%. The best performance for CRT response prediction occurred with SVM model, which propos...
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research

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Peripartum cardiomyopathy (PPCM) is a potentially life ‐threatening condition typically presenting as heart failure with reduced ejection fraction (HFrEF) in the last month of pregnancy or in the months following delivery in women without another known cause of heart failure. This updated position statement summarizes the knowledge about pathophysiolo gical mechanisms, risk factors, clinical presentation, diagnosis and management of PPCM. As shortness of breath, fatigue and leg oedema are common in the peripartum period, a high index of suspicion is required to not miss the diagnosis. Measurement of natriuretic peptides,...
Source: European Journal of Heart Failure - Category: Cardiology Authors: Tags: Position Paper Source Type: research
ConclusionsCongestive heart failure is a rare complication in acromegaly-induced cardiomyopathy (occurs in only 3% of patients). Early diagnosis and treatment with curative drugs more than cardiovascular implantable electronic devices might lead to better surgical outcomes in this group of patients.
Source: Journal of Medical Case Reports - Category: General Medicine Source Type: research
ConclusionsShorter time from onset of QRS to beginning of fragmentation is a simple ECG marker to predict non-responsive patients to CRT.ResumenObjetivoLa terapia de resincronización cardíaca (TRC) es una opción eficaz en el tratamiento de los pacientes con insuficiencia cardíaca y QRS ancho. Se ha demostrado que la presencia de un QRS fragmentado (QRS-f) en el electrocardiograma (ECG) de 12 derivaciones se asocia con una no respuesta a la TRC. El objetivo de este estudio es valorar si la aparición de la fragmentación (intervalo Q-f) es importante en la respuesta a la TRC.Mé...
Source: Revista Clinica Espanola - Category: Internal Medicine Source Type: research
A 60-something male had a syncopal episode.  911 was called.  The patient had no complaint of chest pain or shortness of breath. A prehospital ECG was recorded:Limb leadsPrecordial LeadsThere is ST Elevation in V1-V3, and in aVL, with reciprocal ST depression in II, III, and aVF.There is also some ST depression in V5 and V6, and ST elevation in aVR.What do you think?The medics interpreted the ST elevation, with reciprocal ST depression, as STEMI, and activated the cath lab.Note that you cannot see the entire QRS on the prehospital ECG.  The R-waves in leads II and III are cut off.  The S-waves in V...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Heart failure (HF) is a highly-prevalent progressive disease, with high mortality rate. Up to 50% of deaths are sudden, mostly from ventricular tachyarrhythmias (VT). The HF –VT relationship is reciprocal, because arrhythmias contribute to cardiomyopathy through remodeling processes. Electrophysiological (EP) abnormalities in HF involve multiple scales, from molecular modification of ion-channels and alteration of cellular calcium cycling, to structural remodeling of cardiac tissue. At the cellular scale, the changes can promote arrhythmia triggers in the form of delayed and early afterdepolarizations.
Source: Heart Rhythm - Category: Cardiology Authors: Source Type: research
Heart failure (HF) is a highly prevalent progressive disease, with a high mortality rate. Up to 50% of deaths are sudden, mostly from ventricular tachyarrhythmias (VTs). The HF –VT relationship is reciprocal because arrhythmias contribute to cardiomyopathy through remodeling processes. Electrophysiologic (EP) abnormalities in HF involve multiple scales, from molecular modification of ion channels and alteration of cellular calcium cycling, to structural remodeling of car diac tissue. At the cellular scale, the changes can promote arrhythmia triggers in the form of delayed and early afterdepolarizations.
Source: Heart Rhythm - Category: Cardiology Authors: Tags: Editorial Commentary Source Type: research
Conclusion: LV ejection fraction along with specific electrocardiographic criteria remains the cornerstone of CRT patient selection. Echocardiography is a non-invasive, cost-effective, highly reproducible method with certain limitations and accuracy that is affected by measurement errors. Echocardiography can assist with the identification of the appropriate electromechanical substrate of CRT response and LV lead placement. The targeted approach can improve the haemodynamic response, as also the patient-specific parameters estimation. PMID: 29387277 [PubMed]
Source: Open Cardiovascular Medicine Journal - Category: Cardiology Tags: Open Cardiovasc Med J Source Type: research
Abstract BACKGROUND: Myocardial fibrosis is associated with poor prognosis in nonischemic dilated cardiomyopathy (NIDCM) patients. The Selvester QRS score on 12-lead electrocardiogram is associated with both the amount of myocardial scar and poor prognosis in myocardial infarction patients. However, its use in NIDCM patients is limited. We investigated the prognostic value of the QRS score and its association with collagen volume fraction (CVF) in NIDCM patients. METHODS: We enrolled 91 consecutive NIDCM patients (66 men, 53±13 years) without permanent pacemakers or cardiac resynchronization therapy de...
Source: Journal of Cardiology - Category: Cardiology Authors: Tags: J Cardiol Source Type: research
We very much appreciate the insightful letter by Niedereret al.1 about our recent publication inEuropace.2 Most of the scientific evidence supporting the hypothetical superiority of left ventricular endocardial pacing comes from animal studies using canine models or simulation studies also based on this model.3 Unfortunately, these results have not been reproduced in clinical studies. The large multicentre prospective human trial ALternate Site Cardiac ReSYNChronization (ALSYNC), which included only patients who had failed or were unsuitable for conventional cardiac resynchronization therapy (CRT), showed that the rate of ...
Source: Europace - Category: Cardiology Source Type: research
We present the case of a 69-year-old woman with dilated cardiomyopathy who underwent cardiac resynchronization therapy. Preoperative electrocardiography-gated contrast-enhanced computed tomography revealed the inferolateral wall of her significantly dilated and leftward-rotated heart was close to the descending aorta, and the descending aorta compressed the sandwiched inferolateral branch of the coronary vein. Retrograde coronary venography performed at the time of device implantation confirmed focal stenosis of the inferolateral branch of the coronary vein.
Source: Journal of Arrhythmia - Category: Cardiology Source Type: research
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