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4D Flow Cardiac Magnetic Resonance FOR Post Myocardial Infarction left ventricular thrombus

4D 血流心脏磁共振检查心肌梗死后左心室血栓

基本信息

批准号：
10208944
负责人：
Philip Angelo Corrado
金额：
$ 0.48万
依托单位：
UNIVERSITY OF WISCONSIN-MADISON
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-01 至 2021-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10208944
关键词：
3-Dimensional 3D Print 4D MRI Acute myocardial infarction Age Aneurysm Anticoagulation Apical Atrial Fibrillation Blood Blood Volume Blood flow Cardiac Cardiovascular Diseases Cardiovascular system Characteristics Chest Clinical Data Complex Complication Data Data Set Detection Development Event Fostering Functional disorder Funding Future Gender Goals Gold Heart Atrium Heart Rate Hemorrhage Heterogeneity Hybrids Image Image Analysis Imaging Techniques Impairment In Vitro Investigation Kinetics Lead Left Left Ventricular Ejection Fraction Left ventricular structure Link Location Magnetic Resonance Magnetic Resonance Imaging Measures Mentors Methods Myocardial Myocardial Infarction Myocardial Reperfusion Noise Patient-Focused Outcomes Patients Pattern Phase Physics Physiologic pulse Physiological Positioning Attribute Problem Solving Pulsatile Flow Pump Qualifying Radial Reference Standards Request for Proposals Research Research Personnel Residual state Resolution Risk Scanning Scheme Stroke Techniques Testing Thrombosis Thrombus Time Training Uncertainty Validation Velocimetries Ventricular Weight Work base career clinical care cohort high risk image reconstruction imaging approach improved improved outcome in vivo indexing insight interest myocardial infarct sizing novel optical imaging particle skills spatiotemporal stem tool vector

项目摘要

Project Summary/Abstract Left ventricular thrombus (LVT) provides a substrate for embolic events and a rationale for anticoagulation. De- spite advances in coronary reperfusion, LVT remains common after ST elevation myocardial infarction (MI)– occurring in up to 1 in 5 patients with MI involving the LV apex. Predictors of LVT are limited, as evidenced by data that over half of cases occur without marked global LV dysfunction or aneurysm. Uncertainty as to who will develop LVT may explain clinical data that have shown anticoagulation to increase bleeding without decreasing stroke in seemingly at risk post-MI groups. Given the seriousness of stroke and bleeding conferred by LVT and its treatment, improved understanding of LVT is of major importance for the over quarter million people in the U.S. who sustain ST elevation MI each year. Cardiac magnetic resonance (CMR) imaging provides a highly accurate means to identify LVT, but current approaches are limited to predict in whom LVT will occur. This study is predicated on the hypothesis that LVT formation stems from altered LV blood flow and its determinants. To test this, LV blood flow will be quantified via volumetric time resolved “4D flow MRI” - a new method that can measure time-resolved, volumetric velocity vectors in vivo. We will develop a novel imaging approach for accurate assessment of LV flow impairment in in the context of MI. Aim 1 will develop new MRI methods that can be widely applied to quantify left ventricular stasis (low velocities). Specifically, a targeted 4D flow MRI pulse sequence (via radial stack-of-stars acquisition and dual velocity encoding) will be developed to achieve directed flow assessment of the LV with sensitivity to low velocities. Aim 2 will validate the new method: the new targeted acquisition will be compared with conventional full-chest acquisition for similarity to a reference standard (via optical imaging in vitro) or for repeatability in vivo. Aim 3 will test LV flow indices in a pilot cohort of MI patients to evaluate whether apical stasis (regional flow velocity, kinetic energy, residual blood volumes) post-MI is associated with LVT. The project sponsors and collaborators have a track record in successful translational CMR research and MRI physics, uniquely qualifying them to mentor on the proposed work. The novel information to be gained from this research has potential to impact clinical care by more precisely identifying post-MI flow patterns associated with LVT, thereby setting up future trials to test these parameters as predictors of LVT. The skills gained by the PI during this project will position him strongly for a successful independent research career in cardiovascular MRI.

项目概要/摘要左心室血栓 (LVT) 为栓塞事件提供了基础，并为抗凝治疗提供了依据。德- 尽管冠状动脉再灌注取得了进展，但 ST 段抬高型心肌梗死 (MI) 后 LVT 仍然常见– 多达五分之一的 MI 累及左心室心尖部的患者会发生这种情况。 LVT 的预测因素是有限的，如数据显示，超过一半的病例没有明显的整体左心室功能障碍或动脉瘤。不确定谁会来发展 LVT 可以解释临床数据显示抗凝会增加出血而不减少出血看似处于心肌梗死后风险的人群中的中风。鉴于 LVT 造成的中风和出血的严重性，其治疗、提高对 LVT 的了解对于世界上超过 25 万人来说至关重要每年维持 ST 段抬高 MI 的美国人。心脏磁共振 (CMR) 成像提供了高度准确的方法可以识别 LVT，但目前的方法仅限于预测哪些人会发生 LVT。这项研究基于这样的假设：LVT 形成源于左心室血流及其决定因素的改变。到对此进行测试，左室血流量将通过体积时间分辨的“4D 血流 MRI”进行量化——这是一种新方法，可以测量体内时间分辨的体积速度矢量。我们将开发一种新颖的成像方法准确评估 MI 背景下的 LV 血流损伤。目标 1 将开发新的 MRI 方法可广泛应用于量化左心室瘀滞（低速）。具体来说，有针对性的 4D 流 MRI 脉冲将开发序列（通过径向星堆采集和双速度编码）以实现定向对低速敏感的 LV 流量评估。目标 2 将验证新方法：新目标采集将与传统的全胸部采集进行比较，以了解与参考标准的相似性（通过体外光学成像）或体内可重复性。目标 3 将在 MI 患者试点队列中测试 LV 流量指数评估心肌梗死后心尖停滞（区域流速、动能、残余血量）是否与LVT有关。项目发起人和合作者在成功转化 CMR 方面拥有良好的记录研究和核磁共振物理学，使他们有资格指导拟议的工作。小说信息为这项研究的成果有可能通过更精确地识别心梗后血流来影响临床护理与 LVT 相关的模式，从而建立未来的试验来测试这些参数作为 LVT 的预测因子。这 PI 在该项目中获得的技能将为他成功的独立研究生涯奠定基础在心血管 MRI 中。