Metabolic and structural adaptations after acute myocardial infarction as assessed with multimodal CMR

使用多模式 CMR 评估急性心肌梗死后的代谢和结构适应

• 批准号: 391348895
• 负责人: Dr. Mareike Gastl
• 金额: --
• 依托单位: Institut für Biomedizinische Technik
• 依托单位国家: 德国
• 项目类别: Research Fellowships
• 财政年份: 2017
• 资助国家: 德国
• 起止时间: 2016-12-31 至 2018-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/391348895?language=en
• 关键词: Metabolic; structural; adaptations; after; acute

Acute myocardial infarction (AMI) and subsequent ischemic heart disease (IHD) are epidemiologically and economically the most significant diseases in western societies. Although reperfusion therapies have significantly improved patient outcome over the past years, reduction of ischemia-associated remodelling and subsequent prevention of chronic heart failure (CHF) remains challenging. The resulting dynamic adaptations after AMI affect the subsequent healing phase by a complex interplay of cells, structural and metabolic alterations. Those metabolic adaptations are characterized by a “metabolic switch” in myocardial energy supply from predominantly aerobic fatty acid (FA) oxidation to anaerobic glycolysis. Once energy supply cannot be sustained, the impaired energy reserve leads to functional and structural adaptations. Since quantity and quality of structural alterations in the acute phase after AMI are predictors of myocardial adaptation, there is growing evidence of an additional contribution of local myocardial metabolism. Existing non-invasive techniques such as single-photon emission computed tomography (SPECT) and positron emission tomography (PET) exhibit good sensitivity in quantification of cardiac metabolism, but they are failing in adequate loco-regional visualization, lack specificity and use ionising radiation. Cardiovascular Magnetic Resonance (CMR) has successfully been established to characterize myocardial substrate selection (13C- hyperpolarization), energy supply (creatine quantification by chemical exchange saturation transfer (CrEST)) as well as structural tissue adaptation on a microscopic level (diffusion tensor imaging (DTI)). We hypothesize, that metabolic imaging with CMR provides additive information on future cardiac adaptation after AMI for a personalized disease management. Based on this, we aim to combine those novel techniques in a multimodal imaging approach to (I) monitor structural and metabolic changes in the acute phase after AMI and (II) to investigate the impact of structural and metabolic alterations on long-term myocardial remodelling.

急性心肌梗死（AMI）和随后的缺血性心脏病（IHD）是西方社会流行病学和经济学上最重要的疾病。尽管再灌注治疗在过去几年中显著改善了患者的预后，但减少缺血相关的重塑和随后预防慢性心力衰竭（CHF）仍然具有挑战性。AMI后产生的动态适应通过细胞、结构和代谢改变的复杂相互作用影响随后的愈合阶段。这些代谢适应的特征在于心肌能量供应从主要有氧脂肪酸（FA）氧化到无氧糖酵解的“代谢开关”。一旦能量供应不能持续，受损的能量储备会导致功能和结构的适应。由于AMI后急性期结构改变的数量和质量是心肌适应性的预测因子，越来越多的证据表明局部心肌代谢的额外贡献。现有的非侵入性技术，如单光子发射计算机断层扫描（SPECT）和正电子发射断层扫描（PET）在量化心脏代谢方面表现出良好的灵敏度，但它们无法充分局部区域可视化，缺乏特异性和使用电离辐射。已成功建立心血管磁共振（CMR），以表征心肌底物选择（13 C-超极化）、能量供应（通过化学交换饱和转移（CrEST）进行肌酸定量）以及微观水平上的结构组织适应性（扩散张量成像（DTI））。我们假设，CMR代谢成像为个性化疾病管理提供了AMI后未来心脏适应性的额外信息。 基于此，我们的目标是将这些新技术联合收割机结合到多模态成像方法中，以（I）监测AMI后急性期的结构和代谢变化，（II）研究结构和代谢改变对长期心肌重塑的影响。