Cardiopulmonary Manifestations and Translational Potential of a Novel Radiographic Biomarker of Pulmonary Vascular Morphology

肺血管形态学新型放射学生物标志物的心肺表现和转化潜力

• 批准号: 10164847
• 负责人: Andrew Synn
• 金额: $ 8.56万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-03 至 2022-06-02
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10164847
• 关键词: Address; Affect; Algorithmic Software; American; Appearance; Biological Markers; Blood Vessels; Cardiac; Cardiac Catheterization Procedures; Cardiopulmonary; Caring; Chest; Chronic Obstructive Airway Disease; Chronic lung disease; Clinical; Clinical Data; Complement; Data; Databases; Detection; Diagnosis; Diagnostic radiologic examination; Diffuse; Disease; Early Diagnosis; Environment; Epidemiologic Methods; Epidemiologist; Feasibility Studies; Fellowship Program; Framingham Heart Study; Generations; Goals; Gold; Health; Heart; Hospitals; Image; Image Analysis; Imaging Device; Impairment; Incidence; Individual; Institutes; Israel; K-Series Research Career Programs; Laboratories; Lead; Learning; Left; Left Ventricular Ejection Fraction; Link; Lung; Lung diseases; Magnetic Resonance Imaging; Measures; Medical Research; Medical center; Mentors; Methods; Modeling; Morbidity - disease rate; Morphology; Myocardial dysfunction; Outcome; Participant; Patients; Pharmacotherapy; Physicians; Population; Populations at Risk; Procedures; Protocols documentation; Public Health Schools; Pulmonary Emphysema; Pulmonary Heart Disease; Pulmonary Hypertension; Pulmonary artery structure; Research; Resources; Risk; Risk Factors; Role; Scanning; Severities; Smoker; Spirometry; Statistical Methods; Testing; Training; Training Support; Translational Research; Treatment outcome; Venous Engorgements; Ventricular Ejection Fractions; Woman; Work; X-Ray Computed Tomography; base; career; career development; clinical care; clinical imaging; clinical practice; cohort; cost; heart function; hemodynamics; image processing; imaging biomarker; improved; indexing; medical schools; mortality; multidisciplinary; novel; pre-clinical; pressure; quality assurance; screening; skills; study population; tobacco exposure; tool; translational scientist

PROJECT SUMMARY/ABSTRACT Pulmonary hypertension (PH) is a devastating disease that often co-exists with lung disease, such as chronic obstructive pulmonary disease (COPD). This combination is a major cause of morbidity and mortality, and millions of Americans with COPD are at risk. Identifying populations with early PH, who might benefit most from screening and treatment, could reduce this impact. Unfortunately, the gold-standard method of detecting PH is right heart catheterization, a costly, invasive procedure that is not practical for large-scale clinical use. Image analysis has been used in research settings to quantify PH-related vascular changes, such as “pruning,” using computed tomography (CT). Pruning on CT is associated with cardiopulmonary impairment and PH severity in COPD-specific research cohorts; however, little is known about cardiopulmonary manifestations of pruning in healthier populations that may benefit from screening, and it is also unclear how protocol differences between research and clinical CTs impact the technical feasibility of using this measure in a clinical context. The key focus of this project is to advance the translation of this research-based tool into a bedside role by evaluating cardiopulmonary implications of this imaging biomarker in a healthier population at risk for lung disease and PH, and by demonstrating feasibility in clinically acquired CT data. Using data from the generally healthy Framingham Heart Study, the first aim will investigate associations of radiographic pulmonary vascular measures with indicators of pulmonary and right heart dysfunction, while the second will clarify the influence of left heart dysfunction (also a cause of PH) on this radiographic measure. This work will be accomplished by the application of advanced epidemiologic methods, including linear and nonlinear multivariable modeling and interaction analyses. The third aim is a feasibility study applying research-based vascular image analysis to clinically acquired CT scans in a cohort of COPD patients, which will involve modular image processing methods, manipulation of software algorithms, original data generation, and quality assurance procedures. This work will inform the clinical interpretation and translational potential of pulmonary vascular image analysis, and may ultimately improve the clinical approach to patients at risk for PH, including those with lung disease. This project is supported by an outstanding, multidisciplinary team of experts who will provide rigorous training, complemented by formal coursework, for all aspects of the proposed work, as well as mentored career development. The project will be based primarily within the Institute for Lung Health at Beth Israel Deaconess Medical Center, with support from the Harvard School of Public Health, the Applied Chest Imaging Laboratory at Brigham and Women’s Hospital, Harvard Medical School, and the Harvard Combined Pulmonary Fellowship Program, forming a robust environment with unique resources to support the proposed training and research.

项目摘要/摘要 肺动脉高压(PH)是一种破坏性的疾病，通常与肺部疾病共存，如 慢性阻塞性肺疾病(COPD)。这种组合是导致发病率和死亡率的主要原因， 数百万患有慢性阻塞性肺病的美国人正处于危险之中。确定早期PH人群，谁可能受益最大 通过筛查和治疗，可以减少这种影响。不幸的是，检测的黄金标准方法 PH是右心导管术，这是一种昂贵的侵入性手术，不适合大规模临床使用。 图像分析已经在研究环境中被用于量化与PH相关的血管变化，如“修剪”， 使用计算机断层扫描(CT)。CT上的修剪与心肺功能损害和PH相关 COPD特异性研究队列中的严重程度；然而，对慢性阻塞性肺疾病的心肺表现知之甚少 在可能受益于筛查的更健康的人群中进行修剪，也不清楚协议的差异 研究和临床CT之间的差异影响在临床环境中使用这一措施的技术可行性。 该项目的主要重点是推动将这一基于研究的工具转化为床边角色 通过评估这种成像生物标记物在有肺风险的健康人群中的心肺意义 疾病和PH，并通过临床获得的CT数据证明了可行性。使用来自大体上 健康弗雷明翰心脏研究，第一个目标是调查放射学肺血管与 措施与肺和右心功能不全的指标，而第二个将澄清的影响 左心功能不全(也是PH的原因之一)。这项工作将由 应用先进的流行病学方法，包括线性和非线性多变量建模和 交互作用分析。第三个目标是将基于研究的血管图像分析应用于 在一组COPD患者中进行临床获得的CT扫描，这将涉及模块化图像处理 方法、软件算法的操作、原始数据生成和质量保证程序。 这项工作将为肺血管图像分析的临床解释和翻译潜力提供信息， 并可能最终改善对有PH风险的患者的临床方法，包括那些患有肺部疾病的患者。 该项目由一支杰出的多学科专家团队提供支持，他们将提供严格的 培训，辅以正式课程作业，用于拟议工作的所有方面以及有指导的职业生涯 发展。该项目将主要设在贝丝以色列女执事的肺健康研究所内 医学中心，由哈佛大学公共卫生学院、应用胸部成像实验室支持 在布里格姆妇女医院、哈佛医学院和哈佛联合肺部奖学金 计划，形成一个强大的环境，拥有独特的资源来支持拟议的培训和研究。