Diversity Supplement for Real-time Wideband Cardiac MRI for Patients with a Cardiac Implantable Electronic Device

项目摘要/摘要：出于提高心脏成像价值的未满足需求

Project Summary/Abstract: Motivated by an unmet need to increase the value of cardiac imaging in our healthcare system, this proposal seeks to improve the quality and expand the applicability of cardiovascular MR (CMR) for patients with a cardiac implantable electronic device (CIED). CMR delivers better value than other cardiac imaging modalities (SPECT, echocardiography) because patients with a CIED often have underlying structural heart disease and require complex downstream clinical decisions (new or worsening symptoms, VT ablation, battery replacement, CRT upgrades). As a versatile modality, CMR is capable of a comprehensive evaluation including function, perfusion, flow, and scar. Beyond diagnosis, CMR has been shown to predict major adverse cardiac events (MACE) in both ischemic (ICM) and non-ischemic cardiomyopathies (NICM) and to afford guidance for electrophysiologic (EP) procedures. Unfortunately, due to severe image artifacts induced by CIEDs and, to a lesser extent, arrhythmia and/or inability to perform breath- holding during imaging, over 3 million Americans with a CIED may not benefit from a standard CMR. To bridge this gap in cardiac imaging, we propose to combine and apply two cutting-edge, CMR technologies: (1) wideband pulse sequences that are capable of suppressing image artifacts induced by implantable cardioverter defibrillators (ICDs) and (2) compressed sensing (CS) accelerated real-time sequences that are capable of achieving insensitivity to arrhythmia and breathing motion. The scientific premise is supported by our experience (>9 years) in developing and translating wideband and CS. By leveraging our expertise in wideband CMR and resources in CS supported by R01HL138578 & R21EB024315, we have assembled a unique suite of real-time wideband CMR pulse sequences together with inline image reconstruction methods for imaging patients with a CIED. Comprehensive real-time wideband CMR combining evaluation of ventricular function, perfusion, valve function, and scar for assessing new or worsening cardiovascular symptoms will reduce 47% in cost ($1185.67 medicare reimbursement technical and reading fees) and 91% in scan time (25 min) compared to current clinical practice requiring a combination of SPECT ($1544.80, 4 hours) and echocardiography ($707.96, 25 min). For added value, myocardial scar burden assessed by CMR would be useful for predicting MACE and guiding EP procedures in patients with a CIED. The specific aims of this proposal are to: (1) validate real-time wideband CMR methods with a CIED against clinical stress CMR without a CIED, (2) determine whether myocardial scar burden assessed with real-time wideband CMR predicts MACE in patients with an ICD, and (3) determine whether scar assessed with wideband CMR is strongly correlated with scar assessed with electroanatomic mapping. This proposal has high impact potential because the proposed real-time wideband CMR technology would be broadly applicable as a single diagnostic/prognostic/pre-procedural test for a growing number of CIED patients in the US, thereby increasing the value of cardiac imaging for this cohort.