Prediction of Cardiac Resynchronization Therapy Response Using a Lead Placement Score Derived From 4-Dimensional Computed Tomography

• Published in: Circulation. Cardiovascular imaging Vol. 15; no. 8; p. e014165
• Main Authors: Manohar, Ashish, Colvert, Gabrielle M, Yang, James, Chen, Zhennong, Ledesma-Carbayo, Maria J, Kronborg, Mads Brix, Sommer, Anders, Nørgaard, Bjarne L, Nielsen, Jens Cosedis, McVeigh, Elliot R
• Format: Journal Article
• Language: English
• Published: United States 01.08.2022
• Subjects: Cardiac Resynchronization Therapy; Clinical Trials as Topic; Heart Failure - diagnostic imaging; Heart Failure - therapy; Humans; Lipopolysaccharides; Prospective Studies; Retrospective Studies; Tomography; Treatment Outcome; Ventricular Function, Left; four-dimensional computed tomography; heart failure; support vector machine; cardiac resynchronization therapy; heart function tests; ventricular function; cardiac imaging techniques
• DOI: 10.1161/CIRCIMAGING.122.014165
• ISSN: 1941-9651; 1942-0080

Cardiac resynchronization therapy (CRT) is an effective treatment for patients with heart failure; however, 30% of patients do not respond to the treatment. We sought to derive patient-specific left ventricle maps of lead placement scores (LPS) that highlight target pacing lead sites for achieving a higher probability of CRT response. Eighty-two subjects recruited for the ImagingCRT trial (Empiric Versus Imaging Guided Left Ventricular Lead Placement in Cardiac Resynchronization Therapy) were retrospectively analyzed. All 82 subjects had 2 contrast-enhanced full cardiac cycle 4-dimensional computed tomography scans: a baseline and a 6-month follow-up scan. CRT response was defined as a reduction in computed tomography-derived end-systolic volume ≥15%. Eight left ventricle features derived from the baseline scans were used to train a support vector machine via a bagging approach. An LPS map over the left ventricle was created for each subject as a linear combination of the support vector machine feature weights and the subject's own feature vector. Performance for distinguishing responders was performed on the original 82 subjects. Fifty-two (63%) subjects were responders. Subjects with an LPS≤Q (lower-quartile) had a posttest probability of responding of 14% (3/21), while subjects with an LPS≥ Q (upper-quartile) had a posttest probability of responding of 90% (19/21). Subjects with Q <LPS<Q had a posttest probability of responding that was essentially unchanged from the pretest probability (75% versus 63%, =0.2). An LPS threshold that maximized the geometric mean of true-negative and true-positive rates identified 26/30 of the nonresponders. The area under the curve of the receiver operating characteristic curve for identifying responders with an LPS threshold was 87%. An LPS map was defined using 4-dimensional computed tomography-derived features of left ventricular mechanics. The LPS correlated with CRT response, reclassifying 25% of the subjects into low probability of response, 25% into high probability of response, and 50% unchanged. These encouraging results highlight the potential utility of 4-dimensional computed tomography in guiding patient selection for CRT. The present findings need verification in larger independent data sets and prospective trials.