Cardiac resynchronization therapy is a valuable tool to restore left ventricular function in patients experiencing dyssynchronous ventricular activation. However, the non-responder rate is still as high as 40%. Recent studies suggest that left ventricular torsion or specifically the lack thereof might be a good predictor for the response of cardiac resynchronization therapy. Since left ventricular torsion is governed by the muscle fiber orientation and the heterogeneous electromechanical activation of the myocardium, understanding the relation between these components and the ability to measure them is vital. To analyze if locally altered electromechanical activation in heart failure patients affects left ventricular torsion, we conducted a simulation study on 27 personalized left ventricular models. Electroanatomical maps and late gadolinium enhanced magnetic resonance imaging data informed our in-silico model cohort. The angle of rotation was evaluated in every material point of the model and averaged values were used to classify the rotation as clockwise or counterclockwise in each segment and sector of the left ventricle. 88% of the patient models (n = 24) were classified as a wringing rotation and 12% (n = 3) as a rigid-body-type rotation. Comparison to classification based on in vivo rotational NOGA XP maps showed no correlation. Thus, isolated changes of the electromechanical activation sequence in the left ventricle are not sufficient to reproduce the rotation pattern changes observed in vivo and suggest that further patho-mechanisms are involved.

Department of Electrocardiology and Heart Failure Medical University of Silesia Katowice Poland

Department of Electrocardiology Upper Silesian Heart Center Katowice Poland

Division of Cardiology and Structural Heart Diseases Medical University of Silesia Katowice Poland

Institute of Biomedical Engineering Karlsruhe Institute of Technology Karlsruhe Germany

Interventional Cardiac Electrophysiology Group International Clinical Research Center St Anne's University Hospital Brno Czech Republic

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Augustin C. M., Neic A., Liebmann M., Prassl A. J., Niederer S. A., Haase G., et al. (2016). Anatomically Accurate High Resolution Modeling of Human Whole Heart Electromechanics: A Strongly Scalable Algebraic Multigrid Solver Method for Nonlinear Deformation. J. Comput. Phys. 305, 622–646. 10.1016/j.jcp.2015.10.045 PubMed DOI PMC

Bayer J. D., Blake R. C., Plank G., Trayanova N. A. (2012). A Novel Rule-Based Algorithm for Assigning Myocardial Fiber Orientation to Computational Heart Models. Ann. Biomed. Eng. 40, 2243–2254. 10.1007/s10439-012-0593-5 PubMed DOI PMC

Bollen I. A. E., Ehler E., Fleischanderl K., Bouwman F., Kempers L., Ricke-Hoch M., et al. (2017). Myofilament Remodeling and Function Is More Impaired in Peripartum Cardiomyopathy Compared with Dilated Cardiomyopathy and Ischemic Heart Disease. Am. J. Pathol. 187, 2645–2658. 10.1016/j.ajpath.2017.08.022 PubMed DOI

Carreras F., Garcia-Barnes J., Gil D., Pujadas S., Li C. H., Suarez-Arias R., et al. (2011). Left Ventricular Torsion and Longitudinal Shortening: Two Fundamental Components of Myocardial Mechanics Assessed by Tagged Cine-MRI in normal Subjects. Int. J. Cardiovasc. Imaging 28, 273–284. 10.1007/s10554-011-9813-6 PubMed DOI

Cerqueira M. D., Weissman N. J., Dilsizian V., Jacobs A. K., Kaul S., Laskey W. K., et al. (2002). Standardized Myocardial Segmentation and Nomenclature for Tomographic Imaging of the Heart. A Statement for Healthcare Professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. J. Nucl. Cardiol. 9, 240–245. 10.1067/mnc.2002.123122 PubMed DOI

Daubert J.-C., Daubert J.-C., Saxon L., Adamson P. B., Auricchio A., Berger R. D., et al. (2012). 2012 EHRA/HRS Expert Consensus Statement on Cardiac Resynchronization Therapy in Heart Failure: Implant and Follow-Up Recommendations and Management: A Registered branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society; and in Collaboration with the Heart Failure Society of America (HFSA), the American Society of Echocardiography (ASE), the American Heart Association (AHA), the European Association of Echocardiography (EAE) of the ESC and the Heart Failure Association of the ESC (HFA). * Endorsed by the Governing Bodies of AHA, ASE, EAE, HFSA, HFA, EHRA, and HRS. Europace 14, 1236–1286. 10.1093/europace/eus222 PubMed DOI

Eggen M. D., Swingen C. M., Iaizzo P. A. (2009). “Analysis of Fiber Orientation in normal and Failing Human Hearts Using Diffusion Tensor Mri,” in 2009 IEEE international symposium on biomedical imaging: from nano to macro (IEEE; ), 642–645. 10.1109/isbi.2009.5193129 DOI

Fritz T., Wieners C., Seemann G., Steen H., Dössel O. (2014). Simulation of the Contraction of the Ventricles in a Human Heart Model Including Atria and Pericardium. Biomech. Model. Mechanobiol 13, 627–641. 10.1007/s10237-013-0523-y PubMed DOI

Gerach T., Schuler S., Fröhlich J., Lindner L., Kovacheva E., Moss R., et al. (2021). Electro-mechanical Whole-Heart Digital Twins: A Fully Coupled Multi-Physics Approach. Mathematics 9, 1247. 10.3390/math9111247 DOI

Geuzaine C., Remacle J.-F. (2009). Gmsh: A 3-d Finite Element Mesh Generator with Built-In Pre- and post-processing Facilities. Int. J. Numer. Meth. Engng. 79, 1309–1331. 10.1002/nme.2579 DOI

Jadczyk T., Kurzelowski R., Golba K. S., Wilczek J., Caluori G., Maffessanti F., et al. (2021). Local Electromechanical Alterations Determine the Left Ventricle Rotational Dynamics in CRT-Eligible Heart Failure Patients. Sci. Rep. 11. 10.1038/s41598-021-82793-1 PubMed DOI PMC

Jugdutt B. I., Joljart M. J., Khan M. I. (1996). Rate of Collagen Deposition during Healing and Ventricular Remodeling after Myocardial Infarction in Rat and Dog Models. Circulation 94, 94–101. 10.1161/01.cir.94.1.94 PubMed DOI

Kocabay G., Muraru D., Peluso D., Cucchini U., Mihaila S., Padayattil-Jose S., et al. (2014). Normal Left Ventricular Mechanics by Two-Dimensional Speckle-Tracking Echocardiography. Reference Values in Healthy Adults. Revista Española de Cardiología (English Edition) 67, 651–658. 10.1016/j.rec.2013.12.009 PubMed DOI

Leclercq C., Burri H., Curnis A., Delnoy P. P., Rinaldi C. A., Sperzel J., et al. (2019). Cardiac Resynchronization Therapy Non-responder to Responder Conversion Rate in the More Response to Cardiac Resynchronization Therapy with Multipoint Pacing (MORE-CRT MPP) Study: Results from Phase I. Eur. Heart J. 40, 2979–2987. 10.1093/eurheartj/ehz109 PubMed DOI

Lehmonen L., Jalanko M., Tarkiainen M., Kaasalainen T., Kuusisto J., Lauerma K., et al. (2020). Rotation and Torsion of the Left Ventricle with Cardiovascular Magnetic Resonance Tagging: Comparison of Two Analysis Methods. BMC Med. Imaging 20. 10.1186/s12880-020-00473-4 PubMed DOI PMC

Lombaert H., Peyrat J., Croisille P., Rapacchi S., Fanton L., Cheriet F., et al. (2012). Human Atlas of the Cardiac Fiber Architecture: Study on a Healthy Population. IEEE Trans. Med. Imaging 31, 1436–1447. 10.1109/TMI.2012.2192743 PubMed DOI

Marx L., Niestrawska J. A., Gsell M. A. F., Caforio F., Plank G., Augustin C. M. (2021). Efficient Identification of Myocardial Material Parameters and the Stress-free Reference Configuration for Patient-specific Human Heart Models. Quantitative Biol. 10.48550/arXiv.2101.04411 DOI

Niederer S. A., Plank G., Chinchapatnam P., Ginks M., Lamata P., Rhode K. S., et al. (2011). Length-dependent Tension in the Failing Heart and the Efficacy of Cardiac Resynchronization Therapy. Cardiovasc. Res. 89, 336–343. 10.1093/cvr/cvq318 PubMed DOI

Omar A. M. S., Vallabhajosyula S., Sengupta P. P. (2015). Left Ventricular Twist and Torsion. Circ. Cardiovasc. Imaging 8. 10.1161/CIRCIMAGING.115.003029 PubMed DOI

Oostendorp T. F., van Oosterom A., Huiskamp G. (1989). Interpolation on a Triangulated 3d Surface. J. Comput. Phys. 80, 331–343. 10.1016/0021-9991(89)90103-4 DOI

Paoletti Perini A., Sacchi S., Votta C. D., Lilli A., Attanà P., Pieragnoli P., et al. (2016). Left Ventricular Rotational Dyssynchrony before Cardiac Resynchronization Therapy. J. Cardiovasc. Med. 17, 469–477. 10.2459/jcm.0000000000000391 PubMed DOI

Pfaller M. R., Hörmann J. M., Weigl M., Nagler A., Chabiniok R., Bertoglio C., et al. (2018). The Importance of the Pericardium for Cardiac Biomechanics: from Physiology to Computational Modeling. Biomech. Model. Mechanobiol 18, 503–529. 10.1007/s10237-018-1098-4 PubMed DOI

Popescu B. A., Beladan C. C., Călin A., Muraru D., Deleanu D., Roşca M., et al. (2009). Left Ventricular Remodelling and Torsional Dynamics in Dilated Cardiomyopathy: Reversed Apical Rotation as a Marker of Disease Severity. Eur. J. Heart Fail. 11, 945–951. 10.1093/eurjhf/hfp124 PubMed DOI

Rüssel I. K., Götte M. J. W., Bronzwaer J. G., Knaapen P., Paulus W. J., van Rossum A. C. (2009b). Left Ventricular Torsion. JACC: Cardiovasc. Imaging 2, 648–655. 10.1016/j.jcmg.2009.03.001 PubMed DOI

Rüssel I. K., Götte M. J. W., de Roest G. J., Marcus J. T., Tecelão S. R., Allaart C. P., et al. (2009a). Loss of Opposite Left Ventricular Basal and Apical Rotation Predicts Acute Response to Cardiac Resynchronization Therapy and Is Associated with Long-Term Reversed Remodeling. J. Card. Fail. 15, 717–725. 10.1016/j.cardfail.2009.04.007 PubMed DOI

Rüssel I. K., Götte M. J. W. (2011). New Insights in LV Torsion for the Selection of Cardiac Resynchronisation Therapy Candidates. Neth. Heart J. 19, 386–391. 10.1007/s12471-011-0136-y PubMed DOI PMC

Sade L. E., Demir Ö., Atar I., Müderrisoglu H., Özin B. (2008). Effect of Mechanical Dyssynchrony and Cardiac Resynchronization Therapy on Left Ventricular Rotational Mechanics. Am. J. Cardiol. 101, 1163–1169. 10.1016/j.amjcard.2007.11.069 PubMed DOI

Schuler S., Pilia N., Potyagaylo D., Loewe A. (2021). Cobiveco: Consistent Biventricular Coordinates for Precise and Intuitive Description of Position in the Heart - with MATLAB Implementation. Med. Image Anal. 74, 102247. 10.1016/j.media.2021.102247 PubMed DOI

Sengupta P. P., Krishnamoorthy V. K., Korinek J., Narula J., Vannan M. A., Lester S. J., et al. (2007). Left Ventricular Form and Function Revisited: Applied Translational Science to Cardiovascular Ultrasound Imaging. J. Am. Soc. Echocardiography 20, 539–551. 10.1016/j.echo.2006.10.013 PubMed DOI PMC

Sengupta P. P., Tajik A. J., Chandrasekaran K., Khandheria B. K. (2008). Twist Mechanics of the Left Ventricle. JACC: Cardiovasc. Imaging 1, 366–376. 10.1016/j.jcmg.2008.02.006 PubMed DOI

Setser R. M., Kasper J. M., Lieber M. L., Starling R. C., McCarthy P. M., White R. D. (2003). Persistent Abnormal Left Ventricular Systolic Torsion in Dilated Cardiomyopathy after Partial Left Ventriculectomy. J. Thorac. Cardiovasc. Surg. 126, 48–55. 10.1016/S0022-5223(03)00050-3 PubMed DOI

Sillanmäki S., Lipponen J. A., Tarvainen M. P., Laitinen T., Hedman M., Hedman A., et al. (2018). Relationships between Electrical and Mechanical Dyssynchrony in Patients with Left Bundle branch Block and Healthy Controls. J. Nucl. Cardiol. 26, 1228–1239. 10.1007/s12350-018-1204-0 PubMed DOI

Stöhr E. J., Shave R. E., Baggish A. L., Weiner R. B. (2016). Left Ventricular Twist Mechanics in the Context of normal Physiology and Cardiovascular Disease: a Review of Studies Using Speckle Tracking Echocardiography. Am. J. Physiology-Heart Circulatory Physiol. 311, H633–H644. 10.1152/ajpheart.00104.2016 PubMed DOI

Strauss D. G., Selvester R. H., Wagner G. S. (2011). Defining Left Bundle Branch Block in the Era of Cardiac Resynchronization Therapy. Am. J. Cardiol. 107, 927–934. 10.1016/j.amjcard.2010.11.010 PubMed DOI

Strocchi M., Gsell M. A. F., Augustin C. M., Razeghi O., Roney C. H., Prassl A. J., et al. (2020). Simulating Ventricular Systolic Motion in a Four-Chamber Heart Model with Spatially Varying Robin Boundary Conditions to Model the Effect of the Pericardium. J. Biomech. 101, 109645. 10.1016/j.jbiomech.2020.109645 PubMed DOI PMC

Usyk T. P., Mazhari R., McCulloch A. D. (2000). Effect of Laminar Orthotropic Myofiber Architecture on Regional Stress and Strain in the Canine Left Ventricle. J. Elasticity 61, 143–164. 10.1023/A:1010883920374 DOI

van Dalen B. M., Caliskan K., Soliman O. I. I., Nemes A., Vletter W. B., Ten Cate F. J., et al. (2008a). Left Ventricular Solid Body Rotation in Non-compaction Cardiomyopathy: a Potential New Objective and Quantitative Functional Diagnostic Criterion? Eur. J. Heart Fail. 10, 1088–1093. 10.1016/j.ejheart.2008.08.006 PubMed DOI

van Dalen B. M., Vletter W. B., Soliman O. I. I., ten Cate F. J., Geleijnse M. L. (2008b). Importance of Transducer Position in the Assessment of Apical Rotation by Speckle Tracking Echocardiography. J. Am. Soc. Echocardiography 21, 895–898. 10.1016/j.echo.2008.02.001 PubMed DOI