An Integrated and Automated Tool for Quantification of Biomechanics in Fetal and Neonatal Echocardiography

项目摘要 单心室（SV）心脏是一种严重的出生缺陷，患者需要多次姑息手术 生存即使这些手术被认为是成功的，SV心脏也可能发展为心力衰竭（HF）， 导致患者30岁的存活率只有43%。SV的生物力学基础是 进展为HF可以提供关键的有利信息，有助于改善SV患者的结局， 手术计划尽管如此，SV的生物力学仍然没有得到很好的理解。现有超声心动图 分析工具是为成人心脏设计的， 超声心动图因此，目前还没有可用的工具来研究SV心脏的生物力学。 除此之外，诸如射血分数（EF）的常规指标未能捕获SV心脏的生长和重构。 我们以前开发了一种新颖的自动分析工具，可以量化心室生物力学， 常规B超和彩色多普勒记录。我们使用出生前和出生后的正常和 左心发育不全的病人我们同时测量了常规指标（例如，EF），全球纵向 应变和应变率、室间压差和流动能量损失。这种测量方法 使用现有的超声心动图分析工具是不可能的。我们的初步研究结果表明，这些指标 SV与正常出生后心脏之间差异有统计学意义。 我们建议检验舒张期血流、压力和能量损失的差异， 与Fontan手术前后的结果相关，并预测失败的进展。我们将力求 （i）优化和建立我们的新型综合超声心动图的准确性和可靠性 分析SV心脏，随后使用我们的工具建立定量生物力学， 健康和SV心脏之间的血流动力学差异。此外，我们的目标是：（ii）分析SV心脏使用 前瞻性纵向研究，以开发血流动力学演变与 SV心脏的生物力学参数与时间点结局，如胎儿生长和无事件存活率， 新生儿、Fontan期前后。 该项目旨在改善结果的预测，并实现更好的手术计划和临床 SV心脏缺陷儿童的管理。这个项目的目标是建立我们的工具，在临床 实践

PROJECT SUMMARY The single ventricle (SV) heart is a critical birth defect that requires several palliative surgeries for patient survival. Even when these surgeries are considered successful, SV hearts can develop heart failure (HF), resulting in just a 43% 30-years of age survival rate for patients. The SV's biomechanics underlying the progression to HF could provide critical enabling information that could help improve SV patients' outcomes and surgical planning. Despite that, SV biomechanics remain not well understood. Existing echocardiography analysis tools are designed for adult hearts and cannot accurately or reproducibly evaluate fetal and neonatal echocardiograms. Thus, currently, there are no available tools to study the biomechanics of SV hearts. Beyond this, conventional metrics such as ejection fraction (EF) fail to capture SV hearts' growth and remodeling. We previously developed a novel, automated analysis tools that can quantify ventricular biomechanics from routine B-mode and color Doppler recordings. We tested these tools using pre- and postnatal normal and hypoplastic left heart patients. We simultaneously measured conventional metrics (e.g., EF), global longitudinal strain and strain rate, interventricular pressure difference, and flow energy losses. Such measurements have never been possible using existing echocardiogram analysis tools. Our initial findings indicated these metrics differed between SV and normal postnatal hearts, with statistical significance. We propose to test the hypothesis that differences in diastolic flow, pressure, and energy-loss, correlate with pre- and post-Fontan procedure outcomes and predict progression to failure. We will aim to (i) optimize and establish the accuracy and reliability of our novel and integrated echocardiography analysis for SV hearts and subsequently use our tools to establish quantitative biomechanics and hemodynamic differences between healthy and SV hearts. Further, we aim to: (ii) analyze SV hearts using a prospective longitudinal study to develop correlations between the evolution of hemodynamics and biomechanics parameters of SV hearts with time-point outcomes, such as growth and event-free survival at fetal, neonatal, and pre- and post-Fontan stages. This project aims to improve predictions of outcomes and enable better surgical planning and clinical management for children with SV heart defects. This project's goal would be to establish our tools in clinical practice.