PFI-RP: Noninvasive Technology to Determine an Individual's Risk of Having a Heart Attack

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The broader impact/commercial potential of this Partnerships for Innovation-Research Partnerships (PFI-RP) project are far reaching. Cardiovascular disease is the leading cause of death worldwide. Although the treatment of coronary artery disease - the cause of heart attacks - has progressed significantly in recent decades, the number of heart attacks and deaths is increasing, due primarily to the aging population. The cost to the nation is staggering, presently over $300 billion per year, and increasing. Better and more cost-effective diagnostic procedures and treatment options are urgently needed. The objectives of this research are the development of an innovative, noninvasive, computer analysis procedure to precisely assess the risk of a heart attack occurring in an individual patient and the implementation of the procedure in a software product prototype. Upon successful completion of the research, the industrial partner is committed to pursuing clinical trials, FDA approval, bringing the product to the clinic, and commercializing it. This research will improve the diagnosis, prognosis, and treatment of coronary artery disease, thereby reducing cost, risk, unnecessary invasive procedures and, at the same time, producing better outcomes and quality of life. A comprehensive program of dissemination, outreach, and education of PhD and post-doctoral students is proposed that will further broaden the impacts of the project. The proposed project will address an insidious and heretofore unsolved problem in cardiovascular disease, so-called vulnerable plaques. These are lipid pools in the wall of an artery, separated from the lumen by a thin, inflamed, fibrous cap, which upon rupture releases emboli into the blood stream, causing clot formation and blocking flow. Vulnerable plaques are estimated to be the cause of approximately two-thirds of heart attacks, but heretofore their detection and composition could only be determined by invasive procedures. Recent breakthroughs have presented the opportunity to segment vulnerable plaques from CT scans, and identify material constituents, including lipid and calcium content, and fibrous caps, from which patient-specific, computational models can be formulated. These provide, for the first time, the opportunity to noninvasively analyze and study stress states prior to rupture and to perform rupture simulations under circumstances that have, and have not, led to rupture. Risk stratification criteria describing the probability of rupture will be determined from these studies to provide physicians with guidelines for treatment protocols, such as stenting, bypass grafting, aggressive medical therapy, or standard medical therapy including statins, antihypertensives, and lifestyle modifications.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.