Left Ventricular Remodeling in Aortic Insufficiency
主动脉瓣关闭不全的左心室重构
基本信息
- 批准号:7348393
- 负责人:
- 金额:$ 32.64万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2000
- 资助国家:美国
- 起止时间:2000-04-10 至 2010-01-31
- 项目状态:已结题
- 来源:
- 关键词:AlgorithmsAortic Valve InsufficiencyBackBiologicalCardiomyopathiesChronicClinicalConditionControl GroupsDataData SetDatabasesDeltastabDiseaseDobutamineElementsElevationFinite Element AnalysisFollow-Up StudiesGoalsGrantHeartHeart failureInjuryInpatientsLaboratoriesLeftLeft Ventricular DysfunctionLeft Ventricular FunctionLeft Ventricular RemodelingLeft ventricular structureMagnetic Resonance ImagingMapsMeasurementMeasuresMechanicsMedicalMethodologyMitral Valve InsufficiencyModalityModelingMorbidity - disease rateMovementMyocardialMyocardiumNatural HistoryNormal RangeOperative Surgical ProceduresOutpatientsPatientsPersonal SatisfactionPlasmaPostoperative PeriodPrimary idiopathic dilated cardiomyopathyPrincipal InvestigatorProcessProsthesisQuality of lifeQuestionnairesRateRecommendationRecoveryRecruitment ActivityRestRiskSecondary toStagingStatistically SignificantStratificationStressSymptomsSystoleTechniquesTestingTimeTissuesUnited States National Institutes of HealthVentricularVentricular DysfunctionVentricular FunctionVentricular RemodelingVolunteer Groupaortic valvebaseclinical applicationearly onsetfallsindexingmathematical modelmortalitynovelprogramsradiofrequencyresponsesoftware developmentvolunteer
项目摘要
Our NIH grant support over the last four years has allowed us to characterize the stress/strain profile of patients referred for aortic valve replacement (AVR) for chronic severe aortic insufficiency (AI), both before and after successful AVR. Their abnormally elevated preoperative left ventricular (LV) end-systolic stress returned to normal after AVR. Although resting systolic strain was normal before surgery, the strain response to dobutamine was blunted - and neither was normal postoperatively - despite the fact that they were referred for surgery early in the course of their disease (minimally or asymptomatic). This suggests that 1) our clinically applicable, MRI-based stress/strain indices are sensitive enough to consistently detect abnormalities even in minimally or asymptomatic AI patients, and 2) our current recommendations for timing of referral for AVR in this patient subset are not adequate to completely recover these sensitive stress/strain indices of ventricular function. Our data at least partially explain the well-recognized, not-infrequent occurrence of progressive LV dysfunction and heart failure after seemingly successful AVR for chronic AI.
We propose to further define the early stages of the natural history of chronic AI by applying our stress/strain indices to asymptomatic patients who are being followed on medical therapy early in the course of their chronic AI. MRI-based, three-dimensional left ventricular geometrical data sets will be combined with clinically-acquired systolic ventricular loading conditions and advanced finite element modeling techniques to construct and utilize accurate, patient-specific, systolic mathematical models of the heart. We propose to characterize left ventricular systolic stress-strain profiles of patients with isolated aortic insufficiency by defining and graphically displaying quantifiable regional and global, 3D left ventricular 1) end-systolic geometry; 2) end-diastolic geometry; 3) end-systolic stress; 4) systolic strain ( dobutamine); and 5) systolic stress/strain ratio. Follow-up studies will be correlated with onset of symptoms, plasma BNP levels, and referral for aortic valve replacement. If AVR is undertaken, the patients will be studied postoperatively to correlate very early preoperative indices with subsequent recovery of stress/strain indices.
我们过去四年的 NIH 拨款支持使我们能够描述因慢性严重主动脉瓣关闭不全 (AI) 而转诊接受主动脉瓣置换术 (AVR) 的患者在成功 AVR 之前和之后的压力/应变情况。他们术前异常升高的左心室 (LV) 收缩末期压力在 AVR 后恢复正常。尽管术前静息收缩应变正常,但对多巴酚丁胺的应变反应减弱,术后也不正常,尽管事实上他们在病程早期就被转诊接受手术(症状轻微或无症状)。这表明 1) 我们的临床适用的基于 MRI 的压力/应变指数足够敏感,即使在轻微或无症状的 AI 患者中也能持续检测异常,2) 我们目前对该患者亚群转诊 AVR 时机的建议不足以完全恢复这些敏感的心室功能压力/应变指数。我们的数据至少部分解释了慢性 AI 看似成功的 AVR 后常见的进行性左心室功能障碍和心力衰竭的发生,这一点已得到广泛认可。
我们建议通过将我们的压力/应变指数应用于在慢性人工智能病程早期接受药物治疗的无症状患者,进一步定义慢性人工智能自然史的早期阶段。基于 MRI 的三维左心室几何数据集将与临床获得的心室收缩负荷条件和先进的有限元建模技术相结合,以构建和利用准确的、针对患者的心脏收缩数学模型。我们建议通过定义并以图形方式显示可量化的区域和全局 3D 左心室 1) 收缩末期几何形状,来表征孤立性主动脉瓣关闭不全患者的左心室收缩应力应变曲线; 2)舒张末几何; 3)收缩末期压力; 4) 收缩应变(多巴酚丁胺); 5) 收缩应力/应变比。后续研究将与症状发作、血浆 BNP 水平和转诊主动脉瓣置换术相关。如果进行 AVR,将对患者进行术后研究,将非常早期的术前指标与随后的应力/应变指标的恢复联系起来。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
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MICHAEL K PASQUE其他文献
MICHAEL K PASQUE的其他文献
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{{ truncateString('MICHAEL K PASQUE', 18)}}的其他基金
Left Ventricular Distribution Patterns of the Regionally varying Ischemic Myocardial Contractile Substrates Associated with Ischemic Mitral Regurgitation
与缺血性二尖瓣反流相关的局部缺血性心肌收缩基质的左心室分布模式
- 批准号:
9769299 - 财政年份:2018
- 资助金额:
$ 32.64万 - 项目类别:
REGIONAL VENTRICULAR STRAIN METRICS TO PREDICT NEW-ONSET HEART FAILURE COURSE
预测新发心力衰竭病程的区域心室应变指标
- 批准号:
8271119 - 财政年份:2012
- 资助金额:
$ 32.64万 - 项目类别:
REGIONAL VENTRICULAR STRAIN METRICS TO PREDICT NEW-ONSET HEART FAILURE COURSE
预测新发心力衰竭病程的区域心室应变指标
- 批准号:
8800569 - 财政年份:2012
- 资助金额:
$ 32.64万 - 项目类别:
REGIONAL VENTRICULAR STRAIN METRICS TO PREDICT NEW-ONSET HEART FAILURE COURSE
预测新发心力衰竭病程的区域心室应变指标
- 批准号:
8629626 - 财政年份:2012
- 资助金额:
$ 32.64万 - 项目类别:
REGIONAL VENTRICULAR STRAIN METRICS TO PREDICT NEW-ONSET HEART FAILURE COURSE
预测新发心力衰竭病程的区域心室应变指标
- 批准号:
8457103 - 财政年份:2012
- 资助金额:
$ 32.64万 - 项目类别:
Left Ventricular Remodeling in Aortic Insufficiency
主动脉瓣关闭不全的左心室重构
- 批准号:
7169865 - 财政年份:2000
- 资助金额:
$ 32.64万 - 项目类别:
LEFT VENTRICULAR REMODELING IN AORTIC INSUFFICIENCY
主动脉瓣关闭不全的左心室重构
- 批准号:
6091867 - 财政年份:2000
- 资助金额:
$ 32.64万 - 项目类别:
LEFT VENTRICULAR REMODELING IN AORTEC INSUFFICIENCY
主动脉瓣功能不全的左心室重构
- 批准号:
6390731 - 财政年份:2000
- 资助金额:
$ 32.64万 - 项目类别:
LEFT VENTRICULAR REMODELING IN AORTEC INSUFFICIENCY
主动脉瓣功能不全的左心室重构
- 批准号:
6537813 - 财政年份:2000
- 资助金额:
$ 32.64万 - 项目类别:
Left Ventricular Remodeling in Aortic Insufficiency
主动脉瓣关闭不全的左心室重构
- 批准号:
7010745 - 财政年份:2000
- 资助金额:
$ 32.64万 - 项目类别: