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（由申请人提供）：在30%的严重药物难治性心衰患者中，心肌收缩和舒张的局部时间不同步。这种机械非同步化导致不利的心室重构、二尖瓣返流增加和射血分数降低。心脏再同步化治疗（CRT）是一种相对较新的治疗心力衰竭非同步化患者的方法，既能改善急性血流动力学，又能改善长期预后。尽管CRT在许多多中心临床试验中显示出益处，但30%选择CRT的患者在临床或超声心动图终点没有显示出改善。这种低反应率可能部分是由于目前确定非同步性存在和严重程度的方法的局限性。为了克服现有非同步参数的局限性，我们开发了一种新的数学方法来计算组织多普勒成像（TDI）获得的两个心肌组织速度曲线之间的时间延迟。我们的方法利用一个函数来量化收缩期、舒张期或整个心脏周期的TDI数据。本研究的目的是评估我们的方法的能力：1)量化心脏的机械不同步运动，2)预测对CRT的反应。一组年轻、健康、正常的受试者（阴性对照）和已知对CRT有反应的受试者（阳性对照）的初步数据表明，该方法具有良好的敏感性和特异性。本研究的中心假设是，与目前使用的方法相比，我们确定非同步延迟的方法在选择对CRT有反应的患者时更加敏感和特异性。为了验证这一假设，我们将利用一项大型多中心CRT试验（PROSPECT试验）的现有数据集。该项目的具体目标是：