Cardiac Magnetic Resonance IMaging During Arrhythmia

描述（由申请人提供）：本提案的职业发展和研究战略的目的是建立一个独立的临床科学家职业生涯，重点是：1）有助于心律失常病理生理学和消融手术结果的参数的可靠成像，2）理解患者特定结构变化如何影响心律失常传播和对治疗的响应，以及3）发展对心律失常病理生理学的细胞到器官系统水平的理解，这将作为未来工作的基础。我在临床电生理学、成像科学和计算建模方面的背景非常适合通过个体化图像引导治疗来改善心律失常治疗的目标。我的职业发展目标将通过在约翰霍普金斯大学医学院和生物医学工程系的课程工作和指导研究相结合来实现。约翰霍普金斯大学提供了一个刺激的研究和临床环境，并在培养以患者为导向的研究领导者方面有着悠久的历史。该机构在研究心脏电生理学和心律失常病理生理学的细胞到器官水平方面具有特别的优势。该职业发展计划的结构化课程部分将包括MRI研究，图像集成计算建模，临床研究设计和研究伦理的高级主题培训。这个职业发展奖的指导研究部分将集中在心律失常期间的心脏磁共振成像（CMR）。虽然许多快速性心律失常可通过导管消融治愈，但一些常见病症，特别是心房颤动和室性心动过速（VT），通过当前的医学和消融治疗来管理是次优的。心脏磁共振成像（CMR）越来越受到心脏电生理学的关注，因为1）CMR有可能可视化心肌瘢痕和纤维化，这对VT和房颤病理生理学很重要，2）CMR有可能可视化消融组织以及预期消融区域中的间隙。这些间隙可能不会立即传导，因此心律失常可能不会在消融后立即复发，但间隙可以随着时间的推移恢复传导。这种传导恢复可能是消融术后心律失常复发的主要机制。通过CMR可视化间隙并消除这些可视化间隙的能力可能会显著降低消融后VT和房颤复发的高发生率。然而，目前用于对瘢痕、纤维化和消融病变进行成像的高分辨率CMR技术对于常规临床应用而言不够可靠。拟议的研究将进一步开发技术，以在心律失常期间执行更可靠的高分辨率CMR，并将研究相关CMR应用：1）通过在心律失常期间成像局部室壁运动预测成功消融部位，2）使用抗心律失常CMR热成像预测消融充分性。这项工作的主题是提供更具体和个性化的图像引导治疗，以提高心律失常消融术的疗效，速度和安全性。 公共卫生相关性：虽然许多快速性心律失常可通过导管消融治愈，但一些常见病症，特别是心房颤动和室性心动过速（VT），通过当前的医学和消融治疗来管理是次优的。 拟议的研究将进一步开发在心律失常期间进行更可靠的高分辨率心脏磁共振成像（CMR）的技术，并将研究CMR的相关应用：1）通过在心律失常期间成像局部室壁运动预测成功消融部位，2）使用抗心律失常CMR热成像预测消融充分性。 这项工作的主题是提供更具体和个性化的图像引导治疗，以提高心律失常消融术的疗效，速度和安全性。

DESCRIPTION (provided by applicant): The aim of the career development and research strategies of this proposal are to build an independent clinician-scientist career focusing on: 1) reliable imaging of parameters that contribute to arrhythmia pathophysiology and ablation procedure outcome, 2) understanding how patient specific structural variations affect arrhythmia propagation and response to treatment, and 3) developing a cellular to organ system level understanding of arrhythmia pathophysiology, that will serve as a basis for future work. My background in clinical electrophysiology, imaging science, and computational modeling is well suited to the goal of improve arrhythmia treatment through individualized image guided therapy. My career development goals will be achieved through a combination of course work and mentored research at the Johns Hopkins University School of Medicine and Department of Biomedical Engineering. Johns Hopkins provides a stimulating research and clinical environment and has a long history of training leaders in patient-oriented research. The institution has a particular strength in studying the cellular to organ level aspects of cardiac electrophysiology and arrhythmia pathophysiology. The structured coursework portion of this career development program will include training in advanced topics in MRI research, image integrated computational modeling, clinical study design, and research ethics. The mentored research potion of this career development award will focus on cardiac magnetic resonance imaging (CMR) during arrhythmia. While many tachy-arrhythmias are curable by catheter ablation, some common conditions, in particular atrial fibrillation and ventricular tachycardia (VT), are sub-optimally managed by current medical and ablation treatments. Cardiac magnetic resonance imaging (CMR) is of increasing interest to cardiac electrophysiology because 1) CMR has the potential to visualize myocardial scar and fibrosis, which are important to VT and atrial fibrillation pathophysiology, and 2) CMR has the potential to visualize ablated tissue as well as gaps in intended regions of ablation. These gaps may not conduct acutely, so that the arrhythmia may not recur immediately after ablation, but the gaps can regain conduction over time. This recovery of conduction is likely a major mechanism for arrhythmia recurrence after ablation. The ability to visualize gaps with CMR, and eliminate those visualized gaps, would likely dramatically reduce the high incidence of VT and atrial fibrillation recurrence after ablation. Current high-resolution CMR techniques for imaging scar, fibrosis, and ablation lesions, however, are not reliable enough for routine clinical application. The proposed research will further develop techniques to perform more reliable high-resolution CMR during arrhythmia and will investigate related CMR applications of 1) predicting successful ablation sites by imaging regional wall motion during arrhythmia and 2) predicting ablation adequacy using arrhythmia resistant CMR thermography. The theme of this work is to provide more specific and individualized image guided therapy toward the goal of increasing the efficacy, speed, and safety of arrhythmia ablation procedures. PUBLIC HEALTH RELEVANCE: While many tachy-arrhythmias are curable by catheter ablation, some common conditions, in particular atrial fibrillation and ventricular tachycardia (VT), are sub-optimally managed by current medical and ablation treatments. The proposed research will further develop techniques to perform more reliable high-resolution cardiac magnetic resonance imaging (CMR) during arrhythmia and will investigate related CMR applications of 1) predicting successful ablation sites by imaging regional wall motion during arrhythmia and 2) predicting ablation adequacy using arrhythmia resistant CMR thermography. The theme of this work is to provide more specific and individualized image guided therapy toward the goal of increasing the efficacy, speed, and safety of arrhythmia ablation procedures.