Cardiac Magnetic Resonance Imaging and Cardiac Resynchronization Therapy

描述(申请人提供)：这项建议的目的是培养肯尼斯·比尔奇克医学博士的科学发展和临床研究技能，以便他可以成为一名独立的临床研究员。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，包括一台专用的磁共振研究扫描仪、最先进的超声心动图成像设备和一个设备齐全的应激实验室。这项提议将作为在医学博士克里斯托弗·克莱默和共同导师弗雷德里克·爱泼斯坦博士指导下发展独立学术事业的基础。比尔奇克博士的职业发展计划包括完成临床调查硕士学位。心力衰竭(HF)是影响近500万美国人发病率和死亡率的主要原因。比尔奇克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。心脏再同步化治疗(CRT)对心力衰竭患者有很大的潜在临床益处，但由于难以找到合适的患者和实现最佳的左心室(LV)导联放置而受到限制。该项目采用了Cine Dense(利用刺激回波进行位移编码)，这是一种在UVA开发的新的心脏磁共振(CMR)成像方案，即使在扩大和变薄的左心室中也能产生非常高质量的应变数据。该建议的基本假设是，CMR在预测CRT反应方面明显比超声心动图更准确，当LV导联位于显著瘢痕或其附近时，可能的结果是无反应。因此，这项前瞻性研究评估用于再同步的底物的CMR密度评估是否比超声心动图更准确地确定CRT反应(特定目标1)，以及有明显周围疤痕的LV导联部位是否与CRT反应不足有关(特定目标2)。研究参与者将在临床CRT手术后的基线和6个月时进行临床评估、心脏成像、心肺运动试验和神经激素评估，并在CRT后进行为期3年的长期随访。相关性(参见说明)：心力衰竭(HF)是发病率和死亡率的主要原因，有近500万美国人受到影响。CRT对大多数有症状的心衰患者有很大的潜在益处，但由于难以确定合适的候选者，其疗效一直受到限制。这项对接受CRT的心衰患者的电影密度CMR的研究具有很高的公共卫生意义，因为它寻求改进CRT候选者的选择和优化程序。(摘要结束)

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)