modEling appliEd to cardiac rEsynchronization thErapy

conclUsion / 230 of the complex pathophysiologic and electromechanical factors that underlie mechanical dyssynchrony. The goal of this chapter is to present the development, from magnetic resonance imaging (MRI) and diffusion tensor (DT) MRI scans, of individualized three-dimensional (3D) image-based multiscale computational models of ventricular electromechanics that incorporate the deleterious structural, mechanical, and electrophysiologic remodeling associated with dyssynchronous heart failure (DHF), from the level of the protein to that of the intact heart. We then demonstrate how this powerful predictive modeling approach could be used to provide mechanistic insight into heart failure contractile dyssynchrony and to possibly determine the optimal CRT strategy. The development of a predictive model of ventricular electromechanics in the setting of DHF overcomes the inability of current experimental techniques to simultaneously record the 3D electrical and mechanical activity of the heart with high spatiotemporal resolution and thus to provide an understanding of dyssynchrony and CRT effectiveness. The new basicscience insights into the electromechanical behavior that can be acquired with this modeling approach will hopefully lead to rational optimization of CRT delivery and to improvements in the selection criteria for potential CRT candidates.