3D & 4D Coronary Hemodynamics and Local Atherosclerosis

动脉粥样硬化性冠状动脉疾病的发展是复杂的。最近的研究表明，斑块 斑块的形态和成分、局部血流动力学影响临床事件的进展和风险 应激、3D动脉运动、炎症和局部血管信号。在该提案的第一阶段，我们制定了一个 冠状动脉造影与血流动力学三维和四维融合评价方法的研究 血管内超声图像。在第二阶段，我们将开发一种预测动脉粥样硬化进展的方法。 这一预测模型，结合了我们现已成熟的方法和其他因素，将被开发和 随后在冠状动脉粥样硬化性疾病受试者的纵向研究中得到验证。 我们的主要假设是，对冠心病患者进行的一系列体内研究可以为 血管形态、斑块组成、血流动力学和全身炎症等的时间效应 局部动脉粥样硬化进展的血管生物标志物，从而允许预测负荷的变化， 动脉粥样硬化的位置和程度。因此，我们建议： 目的1：进一步完善先前开发的用于血管造影-IVUS融合的图像分析方法 提高几何表示的效率、重复性和3-D/4-D一致性 活体冠状动脉。 目的2：建立体内复杂斑块组成的三维和四维注册评估方法 具有几何正确的冠状动脉解剖和斑块形态，并能够合并 血管系统内的功能和生理测量。 目的3：建立一种从多因素预测体内动脉粥样硬化斑块时间变化的方法 3-D和4-D冠状动脉几何、血流动力学和斑块形态的计算评估 和组合物，伴随着系统性动脉粥样硬化相关生物标志物的测定。 目的4：在50例已确诊患者的系列研究中验证斑块进展预测方法。 动脉硬化。 我们的工作将揭示初始局部斑块属性和成分、血管和 全身炎症环境和血流动力学状况对动脉粥样硬化性疾病中期进展的影响 回归。一旦成功开发，我们的工作将揭示这些复杂和不同的启动子之间的相互作用 动脉粥样硬化。这对临床前动脉粥样硬化患者的临床治疗有一定的指导意义。 以及接受冠状动脉血运重建术和急性冠脉综合征治疗的患者。

The development of atherosclerotic coronary artery disease is complex. Recent work indicates that plaque progression and risk of clinical events are influenced by plaque morphology and composition, local hemodynamic stresses, 3-D arterial motion, inflammation, and local vascular signaling. In Phase I of this proposal, we developed a method for 3-D and 4-D assessment of coronary artery morphology and hemodynamics by fusion of angiographic and intravascular ultrasound images. In Phase II, we will develop a method for predicting atherosclerosis progression. This predictive model, incorporating our now mature methodology with other factors, will be developed and subsequently validated in longitudinal studies of subjects with coronary atherosclerotic disease. Our main hypothesis is that serial in-vivo studies of patients with coronary artery disease can provide insights into the temporal effects of vessel morphology, plaque composition, hemodynamics, and systemic inflammatory and other vascular biomarkers on local atherosclerosis progression, thus allowing the prediction of changes in the burden, location and extent of atherosclerosis. Therefore, we propose to: Aim 1: Further improve the previously developed image analysis methodology for angiography-IVUS fusion to increase efficiency, reproducibility, and 3-D/4-D consistency of the geometric representations of coronary arteries in vivo. Aim 2: Develop a method for in vivo 3-D and 4-D assessment of complex plaque composition in registration with geometrically correct coronary anatomy and plaque morphology with the ability to incorporate functional and physiologic measures within the vasculature. Aim 3: Develop a method for predicting temporal changes in atherosclerotic plaque in vivo from multifactorial computational assessment of 3-D and 4-D coronary geometry, hemodynamics, plaque morphology and composition, with the concomitant determination of systemic atherosclerosis-related biomarkers. Aim 4: Validate the plaque progression prediction method in a serial study of 50 patients with established atherosclerosis. Our work will uncover the relative contribution of initial local plaque properties and composition, the vascular and systemic inflammatory milieu and hemodynamic conditions to intermediate-term atherosclerotic disease progression or regression. Once successfully developed, our work will uncover the interplay of these complex and disparate promoters of atherosclerosis. It will have implications on the clinical management of patients with preclinical atherosclerotic disease as well as those patients undergoing coronary revascularization and treatment of acute coronary syndromes.