Quantification and Characterization of Coronary Atherosclerotic Plaque by CT

CT 冠状动脉粥样硬化斑块的定量和表征

• 批准号: 8044972
• 负责人: Armin A. Zadeh
• 金额: $ 13.97万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-01-17 至 2015-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8044972
• 关键词: Advisory Committees; Agreement; Anatomy; Angiography; Arterial Fatty Streak; Award; Baltimore; Biometry; Calcified; Cardiac; Cardiac Death; Cardiology; Characteristics; Clinical; Clinical Investigator; Clinical Research; Clinical Trials Design; Coronary; Coronary Angiography; Coronary Arteriosclerosis; Coronary artery; Detection; Diagnosis; Enrollment; Environment; Epidemiology; Event; Excision; Faculty; Generations; Goals; Gold; Healthcare Systems; Heart Transplantation; High Prevalence; Histopathology; Hospitals; Human; Image; International; Investigation; Laboratories; Lead; Lesion; Location; Maryland; Master' s Degree; Measurement; Mentors; Methods; Metric; Modeling; Monitor; Multicenter Studies; Myocardial; Myocardial Infarction; Nuclear; Outcome; Outcome Study; Patient Schedules; Patients; Perfusion; Population; Prevention; Prevention strategy; Public Health; Public Health Schools; Relative (related person); Research; Research Personnel; Resources; Risk; Schools; Severities; Slice; Societies; Solid; Stenosis; Stress; Stress Tests; Techniques; Testing; Training; Training Programs; Translating; Ultrasonography; Universities; Validation; Work; X-Ray Computed Tomography; attenuation; base; cardiovascular disorder epidemiology; career; cohort; design; detector; diagnostic accuracy; experience; follow-up; improved; in vivo; medical schools; novel; patient oriented research; population based; prognostic; prospective; statistics; tool

DESCRIPTION (provided by applicant): Dr. Zadeh is an academic cardiologist at the Johns Hopkins Hospital in Baltimore, Maryland. He devoted most of his career to patient oriented research with a particular focus on diagnosis and prevention of coronary artery disease. Dr. Zadeh gathered considerable expertise in the use of intravascular ultrasound, conventional coronary angiography, and cardiac computed tomography for the detection and characterization of coronary artery disease. During his first three years on the faculty in the Division of Cardiology at the Johns Hopkins Hospital he was an integral part of a multicenter, international study to evaluate the accuracy of multi-detector computed tomography (MDCT) to detect obstructive coronary artery disease in comparison to conventional angiography. Dr. Zadeh is now the Associate Director of Cardiac CT at the Johns Hopkins Hospital and the Director of the Cardiac CT coronary angiography core laboratory for a second international study comparing MDCT to nuclear stress perfusion imaging and conventional angiography. Dr. Zadeh's long term career goal is to become an independent clinical investigator with the specific objective to translate the new and abundant information from non-invasive coronary artery imaging into improved cardiac event prediction models for population based application and patient management. Ultimately, his goal is to contribute to a decrease in the rates of myocardial infarction and cardiac death in our society and worldwide by implementing better prevention strategies. This award application is designed to advance Dr. Zadeh from the status of a mentored researcher with a solid background in clinical research but with deficiencies in biostatistics and epidemiology to an independent clinical investigator who is able to design and conduct clinical outcome studies based on experience in coronary imaging and coronary artery disease. The objectives of this award will be accomplished through 1) a comprehensive didactic training program in biomedical statistics and epidemiology and 2) the experience of conducting supervised research, which is directly applicable to his long term goal. Specifically, the focus of the first three years of this award will be intensive course work in biomedical statistics, cardiovascular epidemiology, and trial design at the Bloomberg School of Public Health which will lead to a master degree in public health within 3 years. The proposed research plan consists of three parts. Part 1 consists of a retrospective analysis to validate MDCT assessment of total coronary atherosclerotic plaque volume and plaque characteristics compared to intravascular ultrasound in 32 patients enrolled in the CorE-64 multicenter study. The novel aspects of this analysis are the first attempt to fully quantify total coronary atherosclerotic plaque burden by MDCT in comparison to an established standard and the first use of relative attenuation measurements for a more robust assessment of plaque characterization. Part 2 includes a prospective analysis of 320-slice CT for the assessment of total coronary atherosclerotic plaque volume and plaque characteristics compared to histopathology in 30 patients scheduled to undergo heart transplantation. This will be the first such study using current generation MDCT. The unique opportunity to acquire MDCT images in vivo before heart transplantation analysis and ex vivo immediately after excision in comparison to histopathology will provide invaluable information regarding the ability of MDCT to assess coronary artery disease. Lastly, in a third step these validated methods of coronary atherosclerotic plaque volume and characteristics analysis will be applied to predict the risk of cardiac events in 400 patients who are being enrolled for the CorE-320 multicenter study, a diagnostic accuracy study to compare MDCT assessment of coronary anatomy and myocardial stress perfusion imaging to conventional angiography and nuclear stress testing, during a 5-year follow up. Dr. Zadeh's progress to achieving the status of an independent clinical investigator will be closely monitored by his mentor, co-mentor, and a mentoring advisory committee. The Johns Hopkins University School of Medicine and Bloomberg School of Public provide an outstanding training environment and thus are ideally suited to support Dr. Zadeh's transition to an independent investigator with focus on patient-oriented research. PUBLIC HEALTH RELEVANCE: This research is likely to positively impact our health care system because it proposes and tests tools that may increase our ability to identify patients who are at increased risk of suffering cardiac events and who may benefit from more aggressive treatment. Conversely, the proposed tools may help identifying patients who are at very low risk of suffering cardiac events and in whom treatment can be safely omitted. Resources therefore could be allocated more efficiently and reduce the financial burden on our health care system.

描述（由申请人提供）：Zadeh博士是马里兰州巴尔的摩的约翰·霍普金斯医院的学术心脏病专家。他的职业生涯大部分时间都致力于以患者为导向的研究，特别着眼于诊断和预防冠状动脉疾病。 Zadeh博士在使用血管内超声，常规冠状动脉造影和心脏计算机断层扫描方面的使用方面收集了相当大的专业知识，用于检测和表征冠状动脉疾病。在约翰·霍普金斯医院（Johns Hopkins Hospital）的心脏病学系教职人员的头三年中，他是一项多中心，国际研究的组成部分，旨在评估多探测器计算机断层扫描（MDCT）的准确性，以检测与常规血管造影相比。 Zadeh博士现在是Johns Hopkins医院心脏CT的副主任，也是第二次国际研究的心脏CT冠状动脉血管造影核心实验室主任，将MDCT与核压力灌注成像和常规血管造影进行了比较。 扎德（Zadeh）博士的长期职业目标是成为一名独立的临床研究者，其特定目标是将非侵入性冠状动脉成像的新信息转化为改进的基于人群的应用和患者管理的心脏事件预测模型。最终，他的目标是通过实施更好的预防策略来促进我们社会和世界范围内心肌梗死和心脏死亡率的降低。该奖项的应用旨在将扎德博士从具有临床研究的稳固背景的指导研究人员的地位中推进，但在生物统计学和流行病学方面的缺乏症到独立的临床研究者，他能够根据冠状成像和冠状动脉疾病的经验设计和进行临床结果研究。 该奖项的目标将通过1）生物医学统计和流行病学的全面教学培训计划以及2）进行监督研究的经验，这直接适用于他的长期目标。具体而言，该奖项的前三年的重点将是彭博公共卫生学院的生物医学统计学，心血管流行病学和试验设计的强化课程工作，该课程将在3年内获得公共卫生硕士学位。 拟议的研究计划包括三个部分。第1部分由回顾性分析组成，以验证对Core-64多中心研究的32名患者的MDCT评估对冠状动脉粥样硬化斑块体积和斑块特征的评估。与已建立的标准相比，该分析的新方面是第一次尝试通过MDCT完全量化总冠状动脉粥样硬化斑块负担，并且首次使用相对衰减测量值以更强大的斑块表征评估。第2部分包括对320层CT的前瞻性分析，用于评估总冠状动脉粥样硬化斑块体积和斑块特征与计划接受心脏移植的30名患者相比，与组织病理学相比。这将是使用当前一代MDCT的第一项此类研究。与组织病理学相比，切除后立即在心脏移植分析和离体之前，在体内获取MDCT图像的独特机会将提供有关MDCT评估冠状动脉疾病能力的宝贵信息。最后，在第三步中，将应用这些经过验证的冠状动脉粥样硬化菌斑体积和特征分析方法，以预测400名正在参加Core-320多中心研究的患者中心脏事件的风险，这是一项诊断精度研究，以比较竞争性解剖和心肌启动时的MDCT评估在一次性范围内进行核心启动和核心范围的Inucogration and nuctional unucting in Nucogement in Nucoghation in Nucoghation and Nucoghation，并进行了练习式的想象。 扎德（Zadeh）博士在实现独立临床研究者身份的进展将受到其导师，联合学者和指导咨询委员会的密切监控。约翰·霍普金斯大学医学院和彭博公立学院提供了出色的培训环境，因此非常适合支持扎德博士向独立研究者的过渡，重点是以患者为导向的研究。 公共卫生相关性：这项研究可能会对我们的医疗保健系统产生积极影响，因为它提出和测试工具，这些工具可能会增加我们识别患有遭受心脏事件风险增加并可能受益于更积极治疗的患者的能力。相反，提出的工具可以帮助识别患有心脏事件风险非常低的患者，并且可以安全省略治疗。因此，资源可以更有效地分配，并减轻我们的医疗保健系统的财务负担。