Integrating Coronary Atherosclerosis with Physiologic Features for Optimized Risk Stratification

将冠状动脉粥样硬化与生理特征相结合以优化风险分层

• 批准号: 10364760
• 负责人: James K Min
• 金额: $ 56.05万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-04 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10364760
• 关键词: Acute myocardial infarction; Anatomy; Angiography; Arterial Fatty Streak; Arteries; Behavior; Biomechanics; Blood; Blood flow; Categories; Cessation of life; Characteristics; Clinical; Clinical Data; Coronary; Coronary Arteriosclerosis; Coronary artery; Diagnosis; Dose; Endothelium; Enrollment; Evaluation; Functional disorder; Future; General Population; Goals; Grant; Image; Individual; Ischemia; Liquid substance; Measurement; Methods; Modeling; Morbidity - disease rate; Multicenter Trials; Myocardial Infarction; Necrosis; Nested Case-Control Study; Patient Care; Patient risk; Patients; Pattern; Physiological; Physiology; Property; Quantitative Evaluations; Randomized; Risk; Rotation; Severities; Stable Populations; Stenosis; Stress; Symptoms; Techniques; Thrombus; Time; United States National Institutes of Health; Validation; Work; X-Ray Computed Tomography; acute coronary syndrome; arterial remodeling; attenuation; base; calcification; clinical care; coronary computed tomography angiography; experience; high risk; improved; innovation; insight; mortality; novel; novel diagnostics; particle; patient population; pressure; prognostic; prognostication; residence; risk stratification; shear stress; tool; ultrasound; virtual

PROJECT SUMMARY Coronary artery disease (CAD) is the principal basis of morbidity and mortality worldwide, and more than half of individuals experiencing acute myocardial infarction (AMI) have no premonitory symptoms. Coronary CT angiography is a non-invasive technique that permits low-dose volumetric imaging of the coronary arteries in a single heartbeat. CT is accurate compared to invasive angiography, and angiographic severity of coronary artery disease (CAD) by CT enables prognostication of ACS and death. Beyond luminal narrowing, CT enables quantitative evaluation of an array of atherosclerotic plaque characteristics (APCs). Further, application of computational fluid dynamics to CT enables determination of an array of coronary physiologic characteristics (CPCs), such as fractional flow reserve, endothelial wall shear stress, vorticity, particle resident time, axial plaque stress and plaque structural stress. To date, among CPCs, only ESS—in studies performed by our group—has been evaluated for its influence on future ACS risk, and was done so in select post-ACS populations of patients undergoing invasive imaging. Yet, the remainder of CPCs has not been evaluated for their prognostic importance to ACS risk, and none has been assessed in a stable population without known CAD. Further, combining CPCs with APCs for improved risk stratification of future ACS remains virtually unexplored. The OVERALL HYPOTHESIS of this proposal is that integration of coronary atherosclerosis with coronary physiologic features will improve identification of stable individuals who will subsequently experience ACS beyond any coronary feature alone. We propose 3 aims: AIM 1. To characterize CPCs associated with future ACS. Hypothesis: CPCs within arteries and exerted on plaques that will be implicated in future ACS will differ from CPCs within arteries and exerted on plaques that will not be implicated in future ACS. AIM 2. To integrate CPCs with APCs for enhanced identification of stable individuals who will experience future ACS. Hypothesis: A multi-dimensional framework that integrates the entirety of coronary atherosclerosis and pathophysiologic features will be superior to frameworks that do not integrate coronary atherosclerosis and pathophysiologic features for identification of individuals who will experience future ACS. AIM 3. To validate the clinical tool developed in Aim 2 in stable individuals with suspected CAD. Hypothesis: Applied to a general population of stable individuals with suspected but without known CAD enrolled in the randomized controlled SCOT-HEART trial, a clinical tool that integrates coronary atherosclerosis and coronary pathophysiologic features will be effective for prediction of ACS. If successful, the work in this proposal will provide the rationale for a novel diagnostic and prognostic paradigm that can be readily applied in clinical care of patients with suspected CAD. Further, this work will offer unique insights into the pathophysiology of CAD.

项目摘要 冠状动脉疾病（CAD）是全球发病率和死亡率的主要基础，超过一半 患有急性心肌梗塞（AMI）的人没有预先症状。冠状动脉CT 血管造影是一种非侵入性技术，可在A 单身心跳。与侵入性血管造影和冠状动脉的血管造影严重程度相比，CT是准确的 疾病（CAD）通过CT启用AC和死亡的提示。除了腔内狭窄之外，CT启用 一系列动脉粥样硬化斑块特征（APC）的定量评估。此外，应用 CT的计算流体动力学能够确定一系列冠状动脉生理特征 （CPC），例如分数流量储备，内皮壁剪应力，涡旋，粒子居民时间，轴向斑块 压力和斑块结构应力。迄今为止，在CPC中，仅在我们的小组进行的研究中，只有ESS 对其对未来ACS风险的影响进行了评估，并在某些患者后种群中进行了评估 进行侵入性成像。然而，其余的CPC尚未评估其预后的重要性 ACS风险，并且在没有已知CAD的情况下，没有评估稳定的人口。此外，结合了CPC 使用APC来改善未来AC的风险分层，几乎仍然是出乎意料的。 该提议的总体假设是冠状动脉粥样硬化与 冠状动脉生理特征将改善对随后体验的稳定个体的识别 ACS仅超出任何冠状动脉特征。我们提出3个目标： 目的1。表征与未来AC相关的CPC。假设：动脉内的CPC并执行 在将来将在未来ACS中实施的斑块将与动脉内的CPC不同，并在斑块上施加了斑块 将不会与未来的AC相关。 目标2。将CPC与APC集成，以增强对体验的稳定个人的识别 未来的ACS。假设：一个整体冠状动脉粥样硬化的多维框架 病理生理特征将优于不整合冠状动脉粥样硬化和 用于识别将会经历未来AC的个体的病理生理特征。 目标3。验证在AIM 2中开发的临床工具，该工具在具有可疑CAD的稳定个体中。 假设：应用于稳定个体的一般人群，可疑但没有已知的CAD招募 在随机对照的苏格兰心脏试验中，一种整合冠状动脉粥样硬化和的临床工具 冠状动脉生理特征将有效预测AC。 如果成功，则该提案的工作将为新颖的诊断和预后提供理由 可以容易地应用于可疑CAD患者的临床护理中的范例。此外，这项工作将提供 对CAD的病理生理学的独特见解。