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力衰竭患者中，心肌收缩和舒张的局部时间不同步。这种机械不同步导致不利的心室重塑，二尖瓣返流增加，射血分数降低。心脏起搏治疗（CRT）是一种相对较新的治疗心力衰竭患者的不同步，导致急性血流动力学的好处，以及改善的长期结果。尽管CRT在许多多中心临床试验中显示出获益，但30%选择接受CRT的患者的临床或超声心动图终点未显示出改善。这种反应率低的部分原因可能是目前确定不同步的存在和严重程度的方法的局限性。为了克服现有的不同步参数的局限性，我们已经开发了一种新的数学方法来计算组织多普勒成像（TDI）采集的两个心肌组织速度分布之间的时间延迟。我们的方法利用一个函数来量化收缩期，舒张期，或整个周期的延迟使用TDI数据收集整个心动周期。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，2）预测对CRT的反应。一组年轻、健康、正常受试者（阴性对照）和已知CRT应答者（阳性对照）的初步数据表明该方法具有极好的灵敏度和特异性。这项研究的中心假设是，我们的方法来确定不同步延迟是更敏感和更具体的选择谁响应CRT的患者相比，目前使用的方法。为了检验这一假设，我们将利用一项大型多中心CRT试验（前景试验）的现有数据集。该项目的具体目标是： 1)量化正常、年龄匹配受试者（阴性对照）组的收缩期、舒张期和全周期延迟，并将这些受试者的延迟值与已知CRT应答者（阳性对照）组的延迟值进行比较。2)使用现有的260例患者的大型多中心数据库，评价收缩期、舒张期和全周期延迟预测CRT反应的能力。公共卫生关系：我们建议开发和测试一种新的方法，以改善选择患者谁将受益于心脏起搏器植入。该方法使用基于超声心动图图像数据的信号处理方法。我们将使用现有的260个主题的数据库中的图像。该方法将改善患者选择，因此仅识别将从起搏器植入中受益的受试者，并识别将从起搏器中受益的所有受试者。