Vectorcardiography-derived index allows a robust quantification of ventricular electrical synchrony

JUAN MANUEL FRANCISCO FERNÁNDEZ; SPAGNUOLO, DAMIAN NESTOR; MARIA TERESA POLITI; IVAN ALFREDO TELLO SANTA CRUZ; MIGUEL SCHIAVONE; CESAR CASERES MOINE; HORACIO A AVACA; OSVALDO CHARA

Scientific Reports

Nature Portfolio

Lugar: Berlín; Año: 2022

2045-2322

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 1,914 patients 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.