In search of the arrhythmogenic grey zone within myocardial scar using late gadol

使用晚期 gadol 寻找心肌疤痕内致心律失常的灰色区域

• 批准号: 8279100
• 负责人: DANA C PETERS
• 金额: $ 24.9万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-06-15 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8279100
• 关键词: Ablation; Animals; Area; Arrhythmia; Cardiac; Cardiovascular system; Cells; Cessation of life; Cicatrix; Clinical; Complex; Coronary Arteriosclerosis; Detection; Electrocardiogram; Family suidae; Fibrosis; Gadolinium; Gold; Gray unit of radiation dose; Healed; Heart; Heart Diseases; Heterogeneity; Histology; Image; Image Enhancement; Implantable Defibrillators; Infarction; Investigation; Life; Location; Magnetic Resonance; Magnetic Resonance Imaging; Maps; Measurement; Methods; Microscopic; Modeling; Morphology; Muscle; Muscle Cells; Myocardial; Myocardial Infarction; Myocardium; Patients; Pilot Projects; Reproducibility; Resolution; Risk; Signal Transduction; Site; Source; Tachyarrhythmias; Techniques; Tissues; Ventricular; Ventricular Fibrillation; Ventricular Tachycardia; base; gadolinium oxide; healing; improved; in vivo; interest; simulation; sudden cardiac death; tool; voltage

DESCRIPTION (provided by applicant): Ventricular tachycardia (VT) and fibrillation (VF) are a major cause of sudden cardiac death (SCD) in those with coronary artery disease (CAD). The source of VT/VF is believed to be the arrhythmogenic substrate within scarred myocardium, creating areas prone to reentrant ventricular tachyarrhythmia. Late gadolinium enhancement (LGE) cardiovascular MR (CMR) is the non-invasive gold standard for in-vivo identification of myocardial scar, but its clinical value in treatment or risk stratifying VT patients remains uncertain. LGE CMR has been employed to identify areas which contain a mixture of living cells and fibrosis (tissue heterogeneity), called the 'grey zone' (GZ) (a.k.a. 'peri-infarct zone' or 'arrhythmic border zone'). Numerous studies have shown that the volume of GZ, much more powerfully than the volume of scar, predicts inducibility of VT and arrhythmic death. Our hypothesis is that more accurate identification of GZ is possible, and will increase the power of LGE to predict arrhythmia, risk-stratify for SCD, and identify the arrhythmic border zone for VT ablation. We propose using high spatial resolution LGE to resolve complex scar morphology, and T1- mapping for quantitative identification of GZ. Reverse-contrast LGE, by which GZ is bright and scar is dark, highlights GZ within the scar core. The CMR methods to better classify GZ will be applied to an animal study for histopathological correlation, and a pilot study of VT patients.

描述（由申请人提供）：室性心动过速（VT）和心室颤动（VF）是冠状动脉疾病（CAD）患者心源性猝死（SCD）的主要原因。 VT/VF 的来源被认为是疤痕心肌内的致心律失常基质，产生容易发生折返性室性快速心律失常的区域。晚期钆增强 (LGE) 心血管磁共振 (CMR) 是体内识别心肌疤痕的无创金标准，但其在治疗或对 VT 患者进行风险分层方面的临床价值仍不确定。 LGE CMR 已用于识别包含活细胞和纤维化（组织异质性）混合物的区域，称为“灰色区域”(GZ)（又名“梗死周围区域”或“心律失常边界区域”）。大量研究表明，GZ 的体积比疤痕的体积更能预测 VT 的诱发性和心律失常死亡。我们的假设是，更准确地识别 GZ 是可能的，并且将增加 LGE 预测心律失常、对 SCD 进行风险分层以及识别 VT 消融的心律失常边界区的能力。我们建议使用高空间分辨率 LGE 来解析复杂的疤痕形态，并使用 T1 映射来定量识别 GZ。反向对比 LGE 使 GZ 明亮，疤痕变暗，突出疤痕核心内的 GZ。更好地对 GZ 进行分类的 CMR 方法将应用于组织病理学相关性的动物研究以及 VT 患者的初步研究。