The state of energy in the right ventricle of patients with pulmonary arterial hypertension

肺动脉高压患者右心室能量状态

• 批准号: 10551727
• 负责人: Arash Kheradvar
• 金额: $ 64.53万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-15 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10551727
• 关键词: 3-Dimensional; Address; Assessment tool; Blood; Blood flow; Cardiac Catheterization Procedures; Chronic; Clinical; Data; Deterioration; Diagnosis; Dimensions; Disease Progression; Disease regression; Echocardiography; Healthcare; Heart; Heart Diseases; Human; Hypertension; Image; Kinetics; Measurement; Measures; Medical center; Methods; Monitor; Morbidity - disease rate; Nature; Patients; Periodicals; Process; Pulmonary Heart Disease; Reference Standards; Reproducibility; Right Ventricular Dysfunction; Right ventricular structure; Structure; Study Subject; Subjects Selections; Techniques; Testing; Time; Velocimetries; Ventricular; Viscosity; Work; advanced disease; cardiac magnetic resonance imaging; care burden; clinical diagnosis; cohort; cost; ethnic diversity; experience; feasibility testing; follow-up; hemodynamics; imaging modality; mortality; non-invasive imaging; particle; pressure; prospective; pulmonary arterial hypertension; pulmonary arterial pressure; right ventricular failure; standard of care; success; two-dimensional

PROJECT SUMMARY/ABSTRACT Pulmonary arterial hypertension (PAH) is a progressive cardiopulmonary disease with a high mortality rate. In most cases, PAH-induced chronic pressure overload leads to right ventricle (RV) failure. Right heart catheterization (RHC) is currently the gold standard test for PAH diagnosis and follow-up. Furthermore, repeated RHC should be considered in patients who experience unexplained clinical deterioration during their clinical course or for periodic follow-up over time. Yet many centers across the world do not routinely perform RHC during follow-up, for a variety of potential reasons, including its invasive nature, cost, or availability. We have recently developed 3D echocardiographic particle image velocimetry (Echo-PIV), which allows high- temporal volumetric assessment of RV hemodynamics. In combination with standard 3D speckle tracking, 3D Echo-PIV enables a comprehensive assessment of hemodynamics and energy state (ventricular kinetic energy/work and viscous energy dissipation) in the RV. The RV energy state reflects the structural and functional changes in the RV that may occur due to PAH. Thus, it can be used as a load-independent measure to assess RV function and monitor disease progression/regression in PAH patients. The project's global hypothesis is that in PAH patients' follow-up, changes in the RV energy state: (1) reflect changes in RHC-derived pulmonary arterial pressures, and (2) are associated with changes in patients' clinical status such that it can be used to monitor disease progression and regression. Given that in more advanced disease, RV dysfunction is present, we will gather a prospective, ethnically diverse cohort of 210 subjects at Cedars-Sinai Medical Center: 70 PAH patients with normal RV function, 70 PAH patients with RV dysfunction, and 70 healthy control subjects. The following Specific Aims will be accomplished: SPECIFIC AIM 1: Investigate the accuracy of 3D Echo-PIV in characterizing 4D flow hemodynamics in the RV using 4D Flow CMR as a reference standard and assess test/retest reproducibility of 3D Echo-PIV in PAH. SPECIFIC AIM 2: Determine the relationship between the noninvasively derived RV energy state and RHC- derived parameters in following up PAH patients and test whether changes in the RV energy state reflect changes in the RHC-derived pulmonary arterial pressures in PAH patients with and without RV dysfunction. SPECIFIC AIM 3: Investigate the feasibility of noninvasive imaging-derived RV energy state for monitoring disease progression/regression in PAH patients. The success of the proposed studies will establish 3D Echo-PIV as a tool for assessment of PAH patients and will: (1) determine the relationship between noninvasive RV imaging and invasive RHC-based hemodynamics, (2) establish whether changes in noninvasive RV energy state reflect changes in the RHC-derived parameters in PAH patients, and (3) facilitate monitoring of disease progression/regression by noninvasive RV energy state in lieu of invasive RHC (current clinical gold standard).

项目概要/摘要 肺动脉高压（PAH）是一种进行性心肺疾病，死亡率很高。在 大多数情况下，PAH 引起的慢性压力超负荷会导致右心室 (RV) 衰竭。右心 导管插入术（RHC）目前是 PAH 诊断和随访的金标准测试。此外，重复 对于在临床治疗期间经历不明原因的临床恶化的患者，应考虑 RHC 课程或定期跟进。然而世界各地的许多中心并不定期进行 RHC 在随访期间，由于各种潜在原因，包括其侵入性、成本或可用性。 我们最近开发了 3D 超声心动图粒子图像测速 (Echo-PIV)，它允许高 RV 血流动力学的时间体积评估。与标准 3D 散斑跟踪相结合，3D Echo-PIV 可对血流动力学和能量状态（心室动力学 RV 中的能量/功和粘性能量耗散）。 RV 能量状态反映了结构和功能 PAH 可能导致 RV 发生变化。因此，它可以用作独立于负载的测量来评估 RV 功能并监测 PAH 患者的疾病进展/消退。 该项目的总体假设是，在PAH患者的随访中，RV能量状态的变化：（1）反映 RHC 衍生的肺动脉压的变化，以及 (2) 与患者临床症状的变化相关 状态，使其可用于监测疾病进展和消退。 鉴于在更晚期的疾病中，存在右心室功能障碍，我们将收集前瞻性的、种族多样化的 Cedars-Sinai 医疗中心的 210 名受试者队列：70 名右心室功能正常的 PAH 患者，70 名 PAH 患者 右心室功能障碍患者和 70 名健康对照受试者。将实现以下具体目标： 具体目标 1：研究 3D Echo-PIV 在表征 RV 中 4D 血流动力学方面的准确性 使用 4D Flow CMR 作为参考标准，评估 3D Echo-PIV 在 PAH 中的测试/再测试再现性。 具体目标 2：确定无创导出的 RV 能量状态与 RHC- 之间的关系 派生参数跟踪 PAH 患者并测试 RV 能量状态的变化是否反映出 有或没有 RV 功能障碍的 PAH 患者 RHC 衍生的肺动脉压的变化。 具体目标 3：研究无创成像衍生的 RV 能量状态用于监测的可行性 PAH 患者的疾病进展/消退。 拟议研究的成功将使 3D Echo-PIV 成为评估 PAH 患者和患者的工具。 将：(1) 确定无创 RV 成像与基于 RHC 的有创血流动力学之间的关系， (2) 确定非侵入性 RV 能量状态的变化是否反映了 RHC 衍生参数的变化 在 PAH 患者中，(3) 通过无创 RV 能量状态促进疾病进展/消退监测 代替侵入性 RHC（当前临床金标准）。