Novel electromechanical phenotypization of heart failure patients candidate for cardiac resynchronization therapy

In daily clinical practice, the CRT candidate is routinely assessed using different and complementary modalities, mainly ECG and echocardiography. ECG is used to measure QRS duration and to describe its morphology, while echocardiography allows calculating deformation parameters. However, there is no integration of the information acquired by the two modalities, and the overall picture remains scattered. We postulate that a multimodal approach, integrating detailed mechanical and electrical information, can provide additional valuable information about the disease in the individual patient. We recently developed a novel method for the in-vivo EM assessment 13, and in the present project we propose to explore the value of various novel descriptors of EM coupling for the prediction of CRT response in a larger population. In detail the project aims at:

1. 1)  comparing measures of strain obtained by electroanatomical mapping with those derived from tagged CMR, and investigate the relation of both strain measures with the sequence of electrical activation.

2. 2)  comparing the presence of low endocardial voltages with the presence of scar tissue as from delayed enhanced CMR, and investigate whether low voltage correlates with shorter diastolic perfusion time;

3. 3)  evaluating the predictive values of the slope and intercept of the relation between local electrical activation and mechanical contraction as well as the presence of low voltage regions with CRT response;

4. 4)  creating a multivariate model including all novel electrical and mechanical measurements as well as scar as predictors of a positive CRT outcome in a 6-month follow-up.