Cardiac Magnetic Resonance Imaging and Cardiac Resynchronization Therapy

描述（由申请人提供）：本提案的目的是培养Kenneth Bilchick，MD的科学发展和临床研究技能，以便他成为独立的临床研究者。弗吉尼亚大学（UVA）将为他提供这个主要学术医学中心的所有资源，包括专用的MR研究扫描仪，最先进的超声心动图成像设备和设备齐全的压力实验室。该提案将作为在导师克里斯托弗克雷默，医学博士的指导下发展独立学术生涯的基础，和共同导师弗雷德里克·爱泼斯坦博士值得注意。Bilchick博士的职业发展计划包括完成临床研究硕士学位。心力衰竭（HF）是影响近500万美国人的发病率和死亡率的主要原因。Bilchick博士的长期研究目标是开发先进的心脏成像技术，并将其应用于心力衰竭和心律失常患者。心脏起搏治疗（CRT）对HF患者具有巨大的潜在临床受益，但受限于难以识别适当患者和实现最佳左心室（LV）电极导线放置。该项目采用电影DENSE（刺激回波位移编码），这是一种在UVA开发的新型心脏磁共振（CMR）成像协议，即使在扩张和变薄的左心室中也能产生非常高质量的应变数据。该提案的主要假设是，在预测CRT反应方面，CMR结合周向机械不同步和瘢痕成像的DENSE评估明显比超声心动图更准确，当LV电极导线位于明显瘢痕内或附近时，可能导致无反应。因此，本前瞻性研究评价了CMR DENSE评估的钙化基质是否比超声心动图更准确地确定CRT反应（特定目标#1），以及左心室电极导线部位周围有明显瘢痕是否与缺乏CRT反应相关（特定目标#2）。研究受试者将在基线和临床CRT手术后6个月进行临床评估、心脏成像、心肺运动试验和神经激素评估，以及CRT后3年的长期随访。相关性（见说明）：心力衰竭（HF）是发病率和死亡率的主要原因，近500万美国人受到影响。CRT对大多数有症状的HF患者有很大的潜在益处，但其疗效受到难以识别合适候选者的限制。这项在接受CRT的HF患者中进行的电影DENSE CMR研究具有高度的公共卫生重要性，因为它旨在改善CRT候选人的选择并优化程序。 (End摘要）

DESCRIPTION (provided by applicant): The purpose of this proposal is to foster the scientific development and clinical research skills of Kenneth Bilchick, MD, in order that he may become an independent clinical investigator. The University of Virginia (UVA) will provide him with all the resources of this major academic medical center for this proposal, including a dedicated MR research scanner, state-of-the-art echocardiographic imaging equipment, and a fully equipped Stress lab. This proposal will serve as the foundation for the development of an independent academic career under the guidance of mentor Christopher Kramer, M.D., and co-mentor Frederick Epstein, Ph.D. Of note. Dr. Bilchick's career development plan includes completion of a Masters degree in Clinical Investigation. Heart failure (HF) is a major cause of morbidity and mortality affecting nearly 5 million Americans. Dr. Bilchick's long-term research goal is to develop and apply advanced cardiac imaging techniques to patients with heart failure and cardiac arrhythmias. Cardiac resynchronization therapy (CRT) has great potential clinical benefit for patients with HF, but is limited by difficulties identifying appropriate patients and achieving optimal left ventricular (LV) lead placement. This project employs cine DENSE (displacement encoding with stimulated echoes), a novel cardiac magnetic resonance (CMR) imaging protocol that was developed at UVA and yields very high quality strain data even in dilated and thinned left ventricles. The primary hypothesis of the proposal is that CMR with DENSE assessment of circumferential mechanical dyssynchrony and scar imaging is significantly more accurate than echocardiography in predicting CRT response, with nonresponse the likely result when the LV lead is positioned in or near significant scar. Therefore, this prospective study evaluates whether CMR DENSE assessment of the substrate for resynchronization provides more accurate determination of CRT response than echocardiography (specific aim #1) and whether LV lead sites with significant surrounding scar are associated with lack of CRT response (specific aim #2). Study participants will have clinical assessment, cardiac imaging, cardiopulmonary exercise testing, and neurohormonal assessment at baseline and 6 months after the clinical CRT procedure, as well as long-term follow-up for 3 years after CRT. RELEVANCE (See instructions): Heart failure (HF) is a major cause of morbidity and mortality with nearly 5 million Americans affected. CRT has great potential benefit for the most symptomatic HF patients, but its efficacy has been limited by difficulty identifying appropriate candidates. This study of cine DENSE CMR in patients with HF undergoing CRT is of high public health importance as it seeks to improve CRT candidate selection and optimize the procedure. (End of Abstract)