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医学博士Kenneth Bilchick的科学发展和临床研究技能，使他能够成为一名独立的临床研究者。弗吉尼亚大学（UVA）将为他提供这个主要学术医疗中心的所有资源，包括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设备齐全的压力实验室。在导师Christopher Kramer（医学博士）和共同导师Frederick Epstein（值得注意的博士）的指导下，该提案将作为独立学术生涯发展的基础。比尔奇克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500万美国人发病和死亡的主要原因。Bilchick博士的长期研究目标是为心力衰竭和心律失常患者开发和应用先进的心脏成像技术。心脏再同步化治疗（CRT）对心衰患者具有巨大的潜在临床益处，但由于难以确定合适的患者和实现最佳左心室（LV）导联放置而受到限制。该项目采用cine DENSE（受激回声位移编码），这是UVA开发的一种新型心脏磁共振（CMR）成像方案，即使在扩张和变薄的左心室也能产生非常高质量的应变数据。该建议的主要假设是CMR与DENSE评估圆周机械不同步和疤痕成像在预测CRT反应方面明显比超声心动图更准确，当左室导联位于或靠近显著疤痕时可能无反应。因此，这项前瞻性研究评估CMR致密评估底物再同步是否比超声心动图更准确地确定CRT反应（特定目的#1），以及具有明显周围瘢痕的左室导联部位是否与缺乏CRT反应相关（特定目的#2）。研究参与者将在基线和临床CRT程序后6个月进行临床评估、心脏成像、心肺运动测试和神经激素评估，并在CRT后进行3年的长期随访。相关性（见说明书）：心力衰竭（HF）是美国近500万人发病和死亡的主要原因。CRT对大多数有症状的HF患者有很大的潜在益处，但由于难以确定合适的候选者，其疗效受到限制。这项在接受CRT的心衰患者中进行cine DENSE CMR的研究具有很高的公共卫生重要性，因为它旨在改善CRT候选人的选择和优化程序。（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)