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

项目概要： 大部分接受心脏移植的患者需要机械循环支持， 作为不适合移植的终末期心力衰竭患者的目的地治疗。然而，在这方面， 临床医生目前无法预测高达40%的患者在治疗后发生右心衰竭。 接受左心室辅助装置如果在术前确定，这些患者可以接受计划的 双心室支持已被证明可以改善结局。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已显示出有限的有效性， 识别这些患者。该项目的假设是， 心室功能和心室-动脉耦联的评估是必要的， 预测接受左心室辅助装置的患者的右心功能和衰竭。 为了研究这一假设，我们将开发和验证新的基于CT的技术， 在一个单一的右心室和肺动脉的全面和同时评估 心跳通过在临床患者中获得这些新的测量沿着金标准估计，我们将 确认是否可以使用cineCT获得心室-动脉耦合的测量值。此外，收购 接受左心室辅助装置植入的临床患者的多模态图像将允许 评估心室-动脉耦合测量是否提供临床预测信息 关于植入后右心室功能（和衰竭）。 该提案包括一项培训计划，旨在解决申请人在技术和专业方面的差距， 帮助他开始独立的研究生涯。具体而言，培训内容包括： 生物统计学课程，以病人为导向的研究，并授予写作，在导航学术培训 工作环境，多模态成像和肺血管生理学指导，临床暴露 心力衰竭患者的管理和治疗，接触潜在的研究生，通过 以成像为重点的课程教学，并通过以下方式增加与国际研究界的接触 出版物以及出席年会和在年会上发言。加州大学圣地亚哥分校是 为了这个奖。除了世界一流的设施和生物工程合作者的支持外， 放射科和心脏科，申请人和研究提案将有很高的概率 成功的好处，并获得校园范围内的资源，如奥特曼临床和 转化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.