Comprehensive Assessment of Right Ventricular and Pulmonary Vascular Function via CT Imaging in Heart Failure Patients

项目总结： 接受心脏移植和心脏移植的大部分患者需要机械循环支持。 为不符合移植条件的终末期心力衰竭患者提供目的地治疗。然而， 临床医生目前无法预测高达40%的患者在接受治疗后发生右心衰竭 接受左心室辅助装置。如果术前确诊，这些患者可以接受有计划的 双室支持，已被证明可以改善结果。不幸的是，术前血流动力学 参数、超声心动图测量和临床风险评分对 确认这些病人的身份。该项目的假设是与负载无关的措施 改善心功能和评估心-动脉偶联是必要的。 接受左心辅助装置的患者右心功能和衰竭的预测。 为了研究这一假设，我们将开发和验证基于CT的新技术，这些技术允许 一次对右室和肺动脉的全面同时评估 心跳。通过获得这些新的测量方法以及临床患者的黄金标准估计，我们将 验证cineCT能否获得室动脉偶联的测量结果。此外，收购 临床植入左心室辅助装置的患者的多模式成像将允许 评价脑室-动脉偶联测量是否提供临床预测性信息 关于植入后的右室功能(和衰竭)。 该提案包括一项旨在解决申请人在技术和专业方面的差距的培训计划 经验，并帮助启动了他的独立研究生涯。具体地说，培训包括：说教 生物统计学的课程，以病人为导向的研究，助学金写作，学术导航培训 工作环境，多模式成像和肺血管生理学方面的指导，临床暴露 心力衰竭患者的管理和治疗，通过接触潜在的研究生 教授以成像为重点的课程，并通过以下方式增加对国际研究界的接触 出版物、出席年会和在年会上发表演讲。加州大学圣地亚哥分校是最佳环境 这个奖项的获奖者。除了世界一流的设施和生物工程方面的合作者的支持外， 放射科和心内科，申请者和研究计划者将有非常高的概率 得益于Altman诊所和Altman诊所等校园范围内的资源并获得这些资源 翻译研究所和医学工程研究所。

Project Summary: Mechanical circulatory support is required by a large percentage of patients who undergo heart transplant and serves as a destination therapy for end-stage heart failure patients who are ineligible for transplant. However, clinicians are currently unable to predict the up to 40% of patients who develop right heart failure after receiving left ventricular assist devices. If identified pre-operatively, these patients could receive planned biventricular support which has been shown to improve outcomes. Unfortunately, pre-operative hemodynamic parameters, echocardiographic measures, and clinical risk scores have shown limited effectiveness in identifying these patients. The hypothesis of this project is that load-independent measures of ventricular function and assessment of ventricular-arterial coupling are necessary to improve prediction of right heart function and failure in patients receiving left ventricular assist devices. To investigate this hypothesis, we will develop and validate novel CT-based techniques which allow for comprehensive and simultaneous assessment of the right ventricle and pulmonary arteries in a single heartbeat. By acquiring these novel measures along with gold-standard estimates in clinical patients, we will validate whether measures of ventricular-arterial coupling can be obtained with cineCT. Furthermore, acquiring multi-modality images in clinical patients undergoing left ventricular assist device implantation will allow for assessment of whether measures of ventricular-arterial coupling provide clinically predictive information regarding post-implantation right ventricular function (and failure). The proposal includes a training plan designed to address gaps in the applicant’s technical and professional experiences and help launch his independent research career. Specifically, the training includes: didactic coursework in biostatistics, patient-oriented research, and grant writing, training in navigating the academic work environment, mentorship in multi-modality imaging and pulmonary vascular physiology, clinical exposure to the management and treatment of heart failure patients, exposure to potential graduate students through teaching of imaging-focused coursework, and increased exposure to the international research community via publications and attendance and presentations at annual meetings. UC San Diego is the optimal environment for this award. In addition to support by world-class facilities and collaborators in the Bioengineering, Radiology, and Cardiology departments, the applicant and research proposal will have a very high probability of success given the benefit of and access to campus-wide resources such as the Altman Clinical and Translational Research Institute and Institute for Engineering in Medicine.