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| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Preprint |
| Published: |
2025
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| Subjects: | |
| Online Access: | https://arxiv.org/abs/2505.15708 |
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| _version_ | 1866910959902130176 |
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| author | Qian, Shuang Ugurlu, Devran Fairweather, Elliot Jones, Richard E Zaidi, Hassan Prasad, Sanjay Halliday, Brian P Hammersley, Daniel J Plank, Gernot Vigmond, Edward Rinaldi, Christopher A Young, Alistair Lamata, Pablo Bishop, Martin Niederer, Steven |
| author_facet | Qian, Shuang Ugurlu, Devran Fairweather, Elliot Jones, Richard E Zaidi, Hassan Prasad, Sanjay Halliday, Brian P Hammersley, Daniel J Plank, Gernot Vigmond, Edward Rinaldi, Christopher A Young, Alistair Lamata, Pablo Bishop, Martin Niederer, Steven |
| contents | Cardiac resynchronization therapy (CRT) guidelines are based on clinical trials with limited female representation and inconsistent left bundle branch block (LBBB) definitions. Conventional QRS duration (QRSd) criteria show variable diagnostic accuracy between sexes, partly due to differences in heart size and remodeling. We evaluated the influence of sex, heart size, LBBB, and conduction delay on QRSd and assessed the diagnostic performance of conventional and indexed QRSd criteria using a population-based modelling approach. Simulated QRSd were derived from electrophysiological simulations conducted in 2627 UK Biobank healthy participants and 359 patients with ischemic heart disease, by modelling LBBB and normal activation combined with/without conduction delay. QRSd criteria under-selected LBBB females and over-selected non-LBBB patients. Indexing by LVEDV and LV mass reduced sex disparities but increased the over-selection in non-LBBB patients. Height-indexed QRSd effectively resolved sex differences and maintained low non-LBBB selection rates, demonstrating superior performance and potential for more equitable CRT selection. |
| format | Preprint |
| id |
arxiv_https___arxiv_org_abs_2505_15708 |
| institution | arXiv |
| publishDate | 2025 |
| record_format | arxiv |
| spellingShingle | In Silico Trials for Sex-Specific patient Inclusion Criteria in Cardiac Resynchronization Therapy: Advancing Precision in Heart Failure Treatment Qian, Shuang Ugurlu, Devran Fairweather, Elliot Jones, Richard E Zaidi, Hassan Prasad, Sanjay Halliday, Brian P Hammersley, Daniel J Plank, Gernot Vigmond, Edward Rinaldi, Christopher A Young, Alistair Lamata, Pablo Bishop, Martin Niederer, Steven Medical Physics Populations and Evolution Cardiac resynchronization therapy (CRT) guidelines are based on clinical trials with limited female representation and inconsistent left bundle branch block (LBBB) definitions. Conventional QRS duration (QRSd) criteria show variable diagnostic accuracy between sexes, partly due to differences in heart size and remodeling. We evaluated the influence of sex, heart size, LBBB, and conduction delay on QRSd and assessed the diagnostic performance of conventional and indexed QRSd criteria using a population-based modelling approach. Simulated QRSd were derived from electrophysiological simulations conducted in 2627 UK Biobank healthy participants and 359 patients with ischemic heart disease, by modelling LBBB and normal activation combined with/without conduction delay. QRSd criteria under-selected LBBB females and over-selected non-LBBB patients. Indexing by LVEDV and LV mass reduced sex disparities but increased the over-selection in non-LBBB patients. Height-indexed QRSd effectively resolved sex differences and maintained low non-LBBB selection rates, demonstrating superior performance and potential for more equitable CRT selection. |
| title | In Silico Trials for Sex-Specific patient Inclusion Criteria in Cardiac Resynchronization Therapy: Advancing Precision in Heart Failure Treatment |
| topic | Medical Physics Populations and Evolution |
| url | https://arxiv.org/abs/2505.15708 |