Prognostic Utility of Absolute Coronary Microvascular Function by PET/CT

描述(申请人提供)：这项建议的目的是促进候选人的科学发展和调查技能，以便她可以成为一名独立的临床研究员。布里格姆妇女医院的非侵入性心血管成像中心为考生提供了理想的环境，让他们在哈佛公共卫生学院攻读公共卫生硕士学位的同时，研究冠状动脉微血管功能的预后价值。通过与临床导师和经验丰富的科学顾问的合作，候选人将获得独立学术生涯发展的基础。心肌缺血、心外膜冠状动脉疾病(CAD)和存活率之间的联系已得到很好的证实。最近，一些临床症状如高血压性心脏病、心肌病和X综合征中的冠状动脉微血管功能障碍在没有梗阻性心外膜CAD的受试者中被报道。初步证据表明，微血管功能障碍与较差的预后相关。直到最近，冠状动脉微血管功能的评估一直受到方法学的限制，因此，其性质和机制仍然是推测的。正电子发射断层扫描(PET)是评价冠状动脉微血管功能的一种非常有效的工具。这项研究的中心目标是用Rubldlum-82PET确定冠状动脉微血管功能的预后价值。候选人已经证明了相对Rubldium-82PET的预后价值，反映了心外膜CAD的严重程度。在特定的目标1-3中，候选人将研究冠状动脉微血管功能对预测猝死、左室重构/心力衰竭风险以及从进展到梗阻性心外膜CAD的主要不良心脏事件的价值。我们预计，这里所概述的拟议研究将提供冠状动脉微血管功能障碍和心脏事件之间的重要机制联系。这些研究的结果将作为设计未来针对改善冠状动脉微血管功能和临床结果的特定疗法的研究的基础。相关性(见说明)：供血至心脏轨迹的大冠状动脉位于表面，可通过注射染料(血管造影术)看到，但进入心肌的血管非常小，在血管造影术中看不到。这些微血管在流向心脏的血液中起着主要作用，特别是在活动期间。这项研究的目的是找出微循环异常是否可以预测心脏病未来不良后果的风险。(摘要结束)

DESCRIPTION (provided by applicant): The purpose of this proposal is to promote scientific development and investigative skills of the candidate in order that she may become an independent clinical investigator. The noninvasive cardiovascular imaging center at the Brigham and Women's Hospital provides the Ideal setting in which the candidate will study the prognostic value of coronary microvascular function, while enrolled in a Masters degree in Public Health at the Harvard School of Public Health. Through the collaboration with the clinical mentor, and highly experienced scientific advisors, the candidate will obtain a foundation for the development of an independent academic career. The link between myocardial ischemia, epicardlal coronary artery disease (CAD) and survival Is well established. More recently, coronary microvascular dysfunction has been reported in several clinical syndromes such as hypertensive heart disease, cardiomyopathy and syndrome X, In subjects without obstructive epicardlal CAD. Preliminary evidence suggests that microvascular dysfunction is associated with worse outcomes. Until recently, evaluation of coronary microvascular function has been impeded by methodological limitations, and hence, its nature and mechanisms remain speculative. Positron emission tomography (PET) represents an extremely powerful tool to assess coronary microvascular function. The central goal of this study is to determine the prognostic value of coronary microvascular function using Rubldlum-82 PET. The candidate has demonstrated the prognostic value of relative Rubldium-82 PET, reflecting severity of epicardlal CAD. In specific Aims 1-3, the candidate will study the value of coronary microvascular function to predict major adverse cardiac events of sudden death, risk of left ventricular remodeling/heart failure, and risks from progression to obstructive epicardlal CAD. We anticipate that the proposed studies outlined here will provide important mechanistic links between coronary microvascular dysfunction and cardiac events. The results of these studies will serve as a foundation to design future studies of specific therapies directed at improving coronary microvascular function and clinical outcomes. RELEVANCE (See instructions): The big coronary arteries supplying blood to the heart course on the surface and are visible by dye injection (angiography), but the vessels entering the heart muscle are very small and not seen on angiography. These microvessels play a major role in blood flow to the heart, especially during activity. The purpose of this study is to find out If microcirculatory abnormalities can predict risk of future adverse outcomes from heart disease. (End of Abstract)