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

项目总结/摘要：出于未满足的需求，以提高我们的心脏成像价值， 该提案旨在提高心血管系统的质量并扩大其适用性。 植入心脏植入式电子器械（CIED）患者的MR（CMR）。CMR提供的价值优于 其他心脏成像方式（SPECT，超声心动图），因为CIED患者通常有 基础结构性心脏病，需要复杂的下游临床决策（新发或恶化 症状、室性心动过速消融、电池更换、CRT升级）。作为一种多功能模态，CMR能够 包括功能、灌注、流量和瘢痕的综合评价。除了诊断之外，CMR一直是 显示可预测缺血性（ICM）和非缺血性的主要不良心脏事件（MACE） 心肌病（NICM），并为电生理（EP）程序提供指导。可惜由于 CIED引起的严重图像伪影，以及较低程度的心律失常和/或无法进行呼吸- 在成像期间，超过300万患有CIED的美国人可能无法从标准CMR中受益。 为了弥补心脏成像中的这一差距，我们建议联合收割机并应用两种尖端CMR技术： (1)宽带脉冲序列能够抑制由可植入的植入物引起的图像伪影 心律转复除颤器（ICD）和（2）压缩感知（CS）加速实时序列， 能够实现对心律失常和呼吸运动的不敏感性。科学的前提是支持 我们在开发和翻译宽带和CS方面的经验（>9年）。通过利用我们的专业知识， R 01 HL 138578和R21 EB 024315支持的CS中的宽带CMR和资源，我们组装了一个 一套独特的实时宽带CMR脉冲序列以及内联图像重建方法 对患有CIED的患者进行成像综合实时宽带CMR联合心室肌功能评价 用于评估新发或恶化的心血管症状的功能、灌注、瓣膜功能和瘢痕将 降低47%的成本（1185.67美元的医疗保险报销技术和阅读费用）和91%的扫描时间（25 与目前需要SPECT（1544.80美元，4小时）和 超声心动图（707.96美元，25分钟）。为了增加价值，通过CMR评估的心肌瘢痕负担将是 可用于预测MACE和指导CIED患者的EP手术。 该建议的具体目标是：（1）用CIED验证实时宽带CMR方法， 无CIED的临床应激CMR，（2）确定是否使用实时评估的心肌瘢痕负荷 宽带CMR可预测植入ICD患者的MACE，以及（3）确定是否使用 宽带CMR与通过电解剖标测评估的瘢痕密切相关。这一建议 影响潜力大，因为拟议的实时宽带CMR技术将广泛适用 作为美国越来越多CIED患者的单一诊断/预后/术前检测，因此 增加了心脏成像对这一群体的价值。

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.