High Resolution MR Imaging of Damaged Myocardium in Patients with Arrhythmia

描述(由申请人提供)： 这份提案描述了一个为期五年的多学科职业发展计划，该计划将使首席调查员--一名核磁共振和心血管放射科医生--成为心血管成像领域一名富有成效的独立、面向患者的调查员。心律失常在缺血性心脏病患者中很常见，可能会导致心脏骤停，在美国，每年有超过45万人死于心脏骤停。它们可以通过药物预防，药物失败率高，毒性频繁，或者通过植入式心脏复律除颤器(ICD)纠正。2003年，美国植入了15万个ICD，这个数字每年都在增长。ICD对生活质量有重大影响，因为ICD的放电被描述为类似于被马踢胸。心脏电标测引导下的射频消融是一种日益重要和普及的治疗方法，可用于治愈无生命危险的心律失常，减少甚至消除未来ICD患者经历的痛苦放电。本研究的重点是开发和应用新的磁共振成像(MRI)技术来改进心脏消融治疗。其主要目的是：(1)开发新的高分辨率MRI技术来评估心肌损伤；(2)证明MRI可以预测由于心肌损伤而导致的心脏电标测异常的分布，从而提高心脏消融治疗的效率；(3)利用MRI来表征心脏消融病变的分布和进展，以预测治疗失败和并发症。职业发展计划有两个主要部分：技术部分和翻译部分。技术部分涉及成像技术的开发，将在生物医学成像领域的一位领先科学家的指导下进行。翻译部分包括由密歇根大学临床研究培训计划提供的教学部分和临床研究部分，其中包括在国际公认的该领域先驱的指导下，在心脏电生理学临床研究中测试成像技术的临床研究设计和统计分析硕士学位。该计划将在一个长期支持以患者为导向的初级调查人员的环境中进行，该环境处于医学成像和心脏电生理学的前沿，拥有广泛的临床、教育和研究资源。相关性：MRI有可能使心脏消融治疗更有效，并预测这种治疗的失败和并发症。这可以极大地改善心律失常患者的生活。

DESCRIPTION (provided by applicant): This proposal describes a five-year multidisciplinary career development program, which will enable the Principal Investigator, an MRI and cardiovascular radiologist, to become a productive independent patient-oriented investigator in cardiovascular imaging. Cardiac arrhythmias, frequent in patients with ischemic heart disease, may lead to sudden cardiac arrest, which claims over 450 000 lives per year in the US. They can be prevented by medication, which has a high failure rate and frequent toxicity, or corrected by an Implantable Cardioverter Defibrillator (ICD). 150 000 ICDs were implanted in the US in 2003, number that is growing every year. ICDs have a significant impact on quality of life, as the discharge from an ICD is described as similar to being kicked in the chest by a horse. Radiofrequency ablation under guidance of cardiac electrical mapping, a therapy rapidly growing in importance and popularity, can be used to cure non-life threatening arrhythmias, and minimize or even eliminate the painful discharges experienced by patients with prospective ICDs. The focus of this research is the development and application of novel magnetic resonance imaging (MRI) techniques to improve cardiac ablation therapy. The principal aims are: (1) to develop novel techniques to perform high resolution MRI to assess myocardial damage, (2) to show that MRI can predict the distribution of abnormalities on cardiac electrical mapping due to myocardial damage, making cardiac ablation therapy more efficient, and (3) use MRI to characterize the distribution and progression of cardiac ablation lesions, in order to predict failure of therapy and complications. The career development program has two major components: a technical component, and a translational component. The technical component involves the development of the imaging techniques, to be performed under the mentorship of a leading scientist in biomedical imaging. The translational component involves a didactic component, provided by the University of Michigan's Training Program in Clinical Research, which leads to a Masters degree in Clinical Research Design and Statistical Analysis, and a clinical research component, that involves the testing of the imaging techniques in clinical studies in cardiac electrophysiology, under the mentorship of an internationally recognized pioneer in the field. The program would take place in an environment which has a long tradition of support for junior patient- oriented investigators, and which is at the cutting edge of both medical imaging and cardiac electrophysiology, with extensive clinical, educational and research resources. Relevance: MRI has the potential to make cardiac ablation therapy more efficient and to predict failure and complications of this therapy. This can dramatically improve the lives of people with arrhythmias.