Invasive Assessment of the Coronary Microcirculation

冠状动脉微循环的侵入性评估

• 批准号: 7012261
• 负责人: WILLIAM F FEARON
• 金额: $ 12.6万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-02-01 至 2009-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7012261
• 关键词: angiography; cardiovascular transplantation; clinical research; diagnostic catheterization; electrocardiography; heart catheterization; heart circulation; human subject; microcirculation; myocardial infarction; patient oriented research; pericardium; positron emission tomography

DESCRIPTION (provided by applicant): Traditionally, evaluation of patients with suspected coronary artery disease has focused on the epicardial coronary system. More recently, investigators have come to appreciate better that the status of the coronary microcirculation can influence significantly long-term morbidity and mortality. Although cardiac transplant recipients commonly develop microcirculatory dysfunction, its timing and its effect on outcomes is unclear. Patients with acute myocardial infarction, despite successful recanalization of an occluded epicardial artery, suffer from microcirculatory dysfunction, both in the infarcted region, as well as in myocardium remote from the infarction. However, the incidence and implications of micro-circulatory dysfunction in areas remote from an acutely infarcted territory are poorly understood. To date, evaluation of the coronary microcirculation has been limited by techniques which incorporate the epicardial system into their assessment. Additionally, most methods require specialized equipment and/or analyses. Others are limited by their qualitative nature. Finally, the majority of methods are noninvasive, yet many patients first present for evaluation of their coronary arterial system in the cardiac catheterization laboratory. The first goal of this project is to demonstrate that an invasive, coronary wire-based method for evaluating the coronary microcirculation is easy to perform and interpret, quantitative, and correlates well with standard methods for assessing the microcirculation. The technique will be validated in a porcine model of epicardial artery and microcirculatory disease. It's correlation with PET imaging, the current gold standard noninvasive method of evaluating the microcirculation, will then be tested in patients with and without microcirculatory dysfunction. The second and third goals of this study will be to apply this technique to gain a better understanding of the role of the microcirculation in the outcomes of cardiac transplant patients and those suffering from acute myocardial infarction.

描述（由申请人提供）： 传统上，对疑似冠状动脉疾病患者的评价集中在心外膜冠状动脉系统。最近，研究人员已经更好地认识到，冠状动脉微循环的状态可以影响显着的长期发病率和死亡率。虽然心脏移植受者通常会发生微循环功能障碍，但其时间和对结果的影响尚不清楚。急性心肌梗死患者，尽管成功地再通了闭塞的心外膜动脉，但在梗死区域以及远离梗死的心肌中均遭受微循环功能障碍。然而，在远离急性梗死区域的微循环功能障碍的发病率和影响知之甚少。 迄今为止，冠状动脉微循环的评价受到将心外膜系统纳入其评估的技术的限制。此外，大多数方法需要专门的设备和/或分析。另一些则受到其质量性质的限制。最后，大多数方法都是无创的，但许多患者首先在心导管实验室进行冠状动脉系统的评价。 本项目的第一个目标是证明用于评价冠状动脉微循环的有创、基于冠状动脉导丝的方法易于执行和解释、定量，并且与用于评估微循环的标准方法相关性良好。该技术将在心外膜动脉和微循环疾病的猪模型中进行验证。它与PET成像的相关性，PET成像是目前评价微循环的金标准非侵入性方法，然后将在有和没有微循环功能障碍的患者中进行测试。本研究的第二个和第三个目标是应用这项技术更好地了解微循环在心脏移植患者和急性心肌梗死患者预后中的作用。