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Protective Role of False Tendon in Subjects with Left Bundle Branch Block: A Virtual Population Study

False tendons (FTs) are fibrous or fibromuscular bands that can be found in both the normal and abnormal human heart in various anatomical forms depending on their attachment points, tissue types, and geometrical properties. While FTs are widely considered to affect the function of the heart, their...

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Autores principales: Lange, Matthias, Di Marco, Luigi Yuri, Lekadir, Karim, Lassila, Toni, Frangi, Alejandro F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4713054/
https://www.ncbi.nlm.nih.gov/pubmed/26766041
http://dx.doi.org/10.1371/journal.pone.0146477
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author Lange, Matthias
Di Marco, Luigi Yuri
Lekadir, Karim
Lassila, Toni
Frangi, Alejandro F.
author_facet Lange, Matthias
Di Marco, Luigi Yuri
Lekadir, Karim
Lassila, Toni
Frangi, Alejandro F.
author_sort Lange, Matthias
collection PubMed
description False tendons (FTs) are fibrous or fibromuscular bands that can be found in both the normal and abnormal human heart in various anatomical forms depending on their attachment points, tissue types, and geometrical properties. While FTs are widely considered to affect the function of the heart, their specific roles remain largely unclear and unexplored. In this paper, we present an in silico study of the ventricular activation time of the human heart in the presence of FTs. This study presents the first computational model of the human heart that includes a FT, Purkinje network, and papillary muscles. Based on this model, we perform simulations to investigate the effect of different types of FTs on hearts with the electrical conduction abnormality of a left bundle branch block (LBBB). We employ a virtual population of 70 human hearts derived from a statistical atlas, and run a total of 560 simulations to assess ventricular activation time with different FT configurations. The obtained results indicate that, in the presence of a LBBB, the FT reduces the total activation time that is abnormally augmented due to a branch block, to such an extent that surgical implant of cardiac resynchronisation devices might not be recommended by international guidelines. Specifically, the simulation results show that FTs reduce the QRS duration at least 10 ms in 80% of hearts, and up to 45 ms for FTs connecting to the ventricular free wall, suggesting a significant reduction of cardiovascular mortality risk. In further simulation studies we show the reduction in the QRS duration is more sensitive to the shape of the heart then the size of the heart or the exact location of the FT. Finally, the model suggests that FTs may contribute to reducing the activation time difference between the left and right ventricles from 12 ms to 4 ms. We conclude that FTs may provide an alternative conduction pathway that compensates for the propagation delay caused by the LBBB. Further investigation is needed to quantify the clinical impact of FTs on cardiovascular mortality risk.
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spelling pubmed-47130542016-01-26 Protective Role of False Tendon in Subjects with Left Bundle Branch Block: A Virtual Population Study Lange, Matthias Di Marco, Luigi Yuri Lekadir, Karim Lassila, Toni Frangi, Alejandro F. PLoS One Research Article False tendons (FTs) are fibrous or fibromuscular bands that can be found in both the normal and abnormal human heart in various anatomical forms depending on their attachment points, tissue types, and geometrical properties. While FTs are widely considered to affect the function of the heart, their specific roles remain largely unclear and unexplored. In this paper, we present an in silico study of the ventricular activation time of the human heart in the presence of FTs. This study presents the first computational model of the human heart that includes a FT, Purkinje network, and papillary muscles. Based on this model, we perform simulations to investigate the effect of different types of FTs on hearts with the electrical conduction abnormality of a left bundle branch block (LBBB). We employ a virtual population of 70 human hearts derived from a statistical atlas, and run a total of 560 simulations to assess ventricular activation time with different FT configurations. The obtained results indicate that, in the presence of a LBBB, the FT reduces the total activation time that is abnormally augmented due to a branch block, to such an extent that surgical implant of cardiac resynchronisation devices might not be recommended by international guidelines. Specifically, the simulation results show that FTs reduce the QRS duration at least 10 ms in 80% of hearts, and up to 45 ms for FTs connecting to the ventricular free wall, suggesting a significant reduction of cardiovascular mortality risk. In further simulation studies we show the reduction in the QRS duration is more sensitive to the shape of the heart then the size of the heart or the exact location of the FT. Finally, the model suggests that FTs may contribute to reducing the activation time difference between the left and right ventricles from 12 ms to 4 ms. We conclude that FTs may provide an alternative conduction pathway that compensates for the propagation delay caused by the LBBB. Further investigation is needed to quantify the clinical impact of FTs on cardiovascular mortality risk. Public Library of Science 2016-01-14 /pmc/articles/PMC4713054/ /pubmed/26766041 http://dx.doi.org/10.1371/journal.pone.0146477 Text en © 2016 Lange et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Lange, Matthias
Di Marco, Luigi Yuri
Lekadir, Karim
Lassila, Toni
Frangi, Alejandro F.
Protective Role of False Tendon in Subjects with Left Bundle Branch Block: A Virtual Population Study
title Protective Role of False Tendon in Subjects with Left Bundle Branch Block: A Virtual Population Study
title_full Protective Role of False Tendon in Subjects with Left Bundle Branch Block: A Virtual Population Study
title_fullStr Protective Role of False Tendon in Subjects with Left Bundle Branch Block: A Virtual Population Study
title_full_unstemmed Protective Role of False Tendon in Subjects with Left Bundle Branch Block: A Virtual Population Study
title_short Protective Role of False Tendon in Subjects with Left Bundle Branch Block: A Virtual Population Study
title_sort protective role of false tendon in subjects with left bundle branch block: a virtual population study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4713054/
https://www.ncbi.nlm.nih.gov/pubmed/26766041
http://dx.doi.org/10.1371/journal.pone.0146477
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