Detection of Left Ventricular Dyssynchrony by Cross-Correlation Analysis

通过互相关分析检测左心室不同步

• 批准号: 7470458
• 负责人: JOHN N OSHINSKI
• 金额: $ 23.21万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-03-15 至 2010-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7470458
• 关键词: Acute; Admission activity; Artificial cardiac pacemaker; Cardiac; Cardiac Output; Clinical; Data; Data Set; Databases; Detection; Diagnosis; Diastole; EFRAC; EKG QRS Complex; Electrocardiogram; End Point; Heart; Heart failure; Hospitals; Image; Lead; Left; Measures; Mechanics; Methodology; Methods; Mitral Valve Insufficiency; Multi-Institutional Clinical Trial; Myocardial Contraction; Myocardial tissue; Myocardium; Outcome; Pacemakers; Patient Selection; Patients; Performance; Pharmaceutical Preparations; Public Health; Publishing; Rate; Receiver Operating Characteristics; Refractory; Relaxation; Reporting; Research Personnel; Sensitivity and Specificity; Severities; Surface; Testing; Time; Tissues; United States; Ventricular; Ventricular Function; Ventricular Remodeling; base; computerized data processing; hemodynamics; implantation; improved; inclusion criteria; normal aging; novel; response; tool

DESCRIPTION (provided by applicant): In thirty percent of patients with severe, drug-refractory heart failure, regional timing of myocardial contraction and relaxation is dyssynchronous. This mechanical dyssynchrony leads to adverse ventricular remodelling, increased mitral regurgitation, and reduced ejection fraction. Cardiac resynchronization therapy (CRT) is a relatively new treatment for heart failure patients with dyssynchrony that results in both acute hemodynamic benefit as well as improved long-term outcome. Despite CRT showing benefits in many multi- center clinical trials, 30% of patients selected for CRT show no improvement by clinical or echocardiographic endpoints. This poor response rate may in part be explained by limitations of current methods to determine the presence and severity of dyssynchrony. To overcome the limitations of existing dyssynchrony parameters, we have developed a new mathematical method to calculate a temporal delay between two myocardial tissue velocity profiles acquired with tissue Doppler imaging (TDI). Our method utilizes a function to quantify either systolic, diastolic, or whole- cycle delays using TDI data collected throughout the cardiac cycle. The objectives of this study are to evaluate the ability of our method to: 1) quantify mechanical dyssynchrony in the heart, and 2) predict response to CRT. Preliminary data in a group of young, healthy, normal subjects (negative controls) and known responders to CRT (positive controls) indicate excellent sensitivity and specificity of the methodology. The central hypothesis of this study is that our method of determining dyssynchrony delays is more sensitive and specific in selecting patients who respond to CRT compared to currently utilized methods. To test the hypothesis, we will utilize an existing data set of from a large, multi-center CRT trial (PROSPECT trial). The specific aims of this project are: 1) Quantify systolic, diastolic and whole-cycle delays in a group on normal, aged-matched subjects (negative controls) and compare delay values in these subjects to delay values in a group known responders to CRT (positive controls). 2) Evaluate the ability of systolic, diastolic, and whole-cycle delays to predict response to CRT using an existing large, multi-center database of 260 patients. PUBLIC HEALTH RELEVANCE: We propose to develop and test a new method to improve selection of patients who will benefit from cardiac pacemaker implantation. The methodology uses signal processing methods based on echocardiographic image data. We will use images from an existing database of 260 subjects. The method would improve patient selection so only subjects who would benefit from pacemaker implantation would be identified, and all subjects who would benefit from a pacemaker would be identified.

描述(申请人提供)：在30%的严重的、药物耐药的心力衰竭患者中，心肌收缩和松弛的局部时间不同步。这种机械不同步会导致不利的心室重构，增加二尖瓣返流，降低射血分数。心脏再同步化治疗(CRT)是一种相对较新的治疗心力衰竭患者不同步的方法，它既能带来急性血流动力学好处，又能改善长期结果。尽管CRT在许多多中心临床试验中显示出好处，但选择接受CRT的患者中，有30%的患者在临床或超声心动图终点没有改善。这种较差的应答率可能部分是由于目前确定不同步的存在和严重程度的方法的局限性。为了克服现有不同步参数的局限性，我们发展了一种新的数学方法来计算由组织多普勒成像(TDI)获得的两个心肌组织速度剖面之间的时间延迟。我们的方法利用一个函数来量化收缩、舒张期或整个周期的延迟，使用在整个心脏周期收集的TDI数据。这项研究的目的是评估我们的方法在以下方面的能力：1)量化心脏的机械不同步，2)预测CRT的反应。在一组年轻、健康、正常的受试者(阴性对照)和CRT已知的应答者(阳性对照)中的初步数据表明，该方法具有极好的敏感性和特异性。这项研究的中心假设是，与目前使用的方法相比，我们确定不同步延迟的方法在选择接受CRT治疗的患者方面更加敏感和具体。为了验证这一假设，我们将利用来自大型多中心CRT试验(PROCESS试验)的现有数据集。该项目的具体目标是： 1)量化一组年龄匹配的正常受试者(阴性对照组)的收缩、舒张期和全周期延迟值，并将这些受试者的延迟值与已知CRT反应组(阳性对照组)的延迟值进行比较。2)利用现有的260名患者的大型多中心数据库，评估收缩、舒张期和全周期延迟预测CRT疗效的能力。公共卫生相关性：我们建议开发和测试一种新的方法，以改进对将受益于心脏起搏器植入的患者的选择。该方法使用基于超声心动图图像数据的信号处理方法。我们将使用现有数据库中260个受试者的图像。该方法将改善患者选择，以便只识别将从心脏起搏器植入中受益的受试者，并识别所有将从起搏器中受益的受试者。