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

项目摘要/摘要：在未得到满足的需求的推动下，增加我们的心脏成像的价值 这项建议旨在提高心血管系统的质量，扩大其适用性 心脏可植入电子设备(CIED)患者的MR(CMR)。CMR提供的价值高于 其他心脏成像手段(SPECT、超声心动图)，因为CIED患者通常有 潜在的结构性心脏病，需要复杂的下游临床决策(新的或恶化的 症状、室性心动过速消融、电池更换、CRT升级)。作为一种多功能的方式，CMR能够 综合评价包括功能、血流、血流、瘢痕等。除了诊断之外，CMR一直是 在缺血性(ICM)和非缺血性两种情况下均可预测主要不良心脏事件(MACE 用于治疗心肌病(NICM)，并为电生理(EP)手术提供指导。不幸的是，由于 由CIED引起的严重图像伪影，以及较轻程度的心律失常和/或无法执行呼吸- 在成像期间持有，超过300万患有CIED的美国人可能无法从标准的CMR中受益。 为了弥合心脏成像领域的这一差距，我们建议结合和应用两种尖端的CMR技术： (1)能够抑制可植入引起的图像伪影的宽带脉冲序列 心律转复除颤器(ICD)和(2)压缩感应(CS)加速的实时序列 能够对心律失常和呼吸运动不敏感。科学的前提是由 我们在开发和翻译宽带和CS方面的经验(&gt；9年)。利用我们在以下领域的专业知识 宽带CMR和CS中的资源由R01HL138578和R21EB024315支持，我们组装了一个 独一无二的实时宽带CMR脉冲序列和在线图像重建方法 对患有CIED的患者进行成像。宽频带CMR综合评价心脏功能的研究 用于评估新的或恶化的心血管症状的功能、灌流、瓣膜功能和疤痕将 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% 分钟)，而目前的临床实践需要结合SPECT(1544.80美元，4小时)和 超声心动图(707.96美元，25分钟)。对于附加值，CMR评估的心肌疤痕负担为 对预测CIED患者的MACE和指导EP手术很有用。 该方案的具体目的是：(1)使用CIED验证实时宽带CMR方法 无CIED的临床应激CMR，(2)确定是否实时评估心肌瘢痕负荷 宽带CMR预测ICD患者的MACE，以及(3)确定SCAR是否通过 通过电解剖标测评估，宽带CMR与SCAR密切相关。这项建议具有 高影响潜力，因为拟议的实时宽带CMR技术将得到广泛应用 作为美国越来越多的CIED患者的单一诊断/预后/术前测试，因此 增加这一队列的心脏成像的价值。

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.