Anatomic and Physiologic Determinants of Vessel-Specific Ischemia by Coronary CT

冠状动脉 CT 血管特异性缺血的解剖学和生理学决定因素

• 批准号: 8727658
• 负责人: James K Min
• 金额: $ 65.48万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8727658
• 关键词: Adverse event; Agreement; Anatomy; Angiography; Arterial Fatty Streak; Atherosclerosis; Blood flow; Characteristics; Clinical; Companions; Comparative Study; Coronary; Coronary Angiography; Coronary Arteriosclerosis; Coronary artery; Data; Development; Diagnosis; Diagnostic; Echocardiography; Effectiveness; Evaluation; Future; Gold; Image; Imagery; Individual; Injury; International; Ischemia; Lesion; Liquid substance; Magnetic Resonance; Magnetic Resonance Imaging; Measures; Medical; Methods; Minority; Multicenter Studies; Myocardial; Myocardial Ischemia; Myocardial perfusion; Myocardium; Parents; Patients; Performance; Perfusion; Physiological; Procedures; Radionuclide Imaging; Relative (related person); Research Personnel; Scanning; Stenosis; Stress; Stress Tests; Testing; Time; Work; X-Ray Computed Tomography; arterial remodeling; base; cost; heart imaging; improved; novel; novel diagnostics; outcome forecast; pressure; prospective; public health relevance

DESCRIPTION (provided by applicant): The OVERALL OBJECTIVE of this proposal is to integrate the anatomic and physiologic information derived from computed tomographic angiograms for the precise identification of coronary artery lesions that cause ischemia. This proposal is a companion study to ISCHEMIA Trial. For patients with stable ischemic heart disease, myocardial ischemia may arise as a consequence of obstructive coronary artery disease (CAD) and is useful for guiding decisions of revascularization. To date, non-invasive stress tests have served as a mainstay for identifying ischemia; these tests include echocardiography, magnetic resonance and myocardial perfusion scintigraphy (MPS). Among these, MPS is performed most commonly due to its ability to identify obstructive CAD, reclassify CAD likelihood, and predict adverse events. CT has emerged as a non-invasive method that permits direct visualization of CAD, demonstrates high performance for obstructive CAD compared to invasive coronary angiography (ICA), and predicts adverse prognosis. Beyond stenosis, CT enables evaluation of additional atherosclerotic plaque characteristics (APCs) that demonstrate high agreement to invasive methods and may augment determination of coronary lesions that cause ischemia. Recent developments in CT also permit physiologic assessment of CAD by applying computational fluid dynamics to typically- acquired CT scans for calculation of coronary artery pressure and flow, thus enabling the non-invasive calculation of fractional flow reserve (FFRCT), a measure of vessel-specific ischemia. The OVERALL HYPOTHESIS of this proposal is that integrating anatomic APCs with physiologic FFRCT will optimize identification of coronary lesions that are ischemia-causing. We propose 3 specific aims: AIM 1: To assess performance of anatomic APCs by CT for diagnosis of vessel-specific ischemia. AIM 2: To assess performance of physiologic FFRCT for diagnosis of vessel-specific ischemia. AIM 3: To directly compare an integrated anatomic-physiologic (APC-FFRCT) CT measure to MPS for diagnosis of lesion-specific ischemia. The work in this proposal will provide the rationale for a novel diagnostic paradigm that is more accurate than conventional stress imaging testing for identifying patients who manifest ischemia and pinpointing the coronary lesions that are the cause; thus, allowing for better selection of individuals for revascularization and eliminating unnecessary invasive procedures.

描述（由申请人提供）：本提案的总体目标是整合从计算机断层扫描血管造影中获得的解剖学和生理学信息，以精确识别导致缺血的冠状动脉病变。该提案是 ISCHEMIA 试验的配套研究。对于患有稳定型缺血性心脏病的患者，阻塞性冠状动脉疾病（CAD）可能会导致心肌缺血，这对于指导血运重建决策很有用。迄今为止，无创压力测试已成为识别缺血的主要手段。这些测试包括超声心动图、磁共振和心肌灌注闪烁扫描（MPS）。其中，MPS 最常用，因为它能够识别阻塞性 CAD、重新分类 CAD 可能性和预测不良事件。 CT 已成为一种非侵入性方法，可直接可视化 CAD，与侵入性冠状动脉造影 (ICA) 相比，显示出阻塞性 CAD 的高性能，并可预测不良预后。除了狭窄之外，CT 还可以评估其他动脉粥样硬化斑块特征 (APC)，这些特征与侵入性方法高度一致，并且可以增强对引起缺血的冠状动脉病变的确定。 CT 的最新发展还允许通过将计算流体动力学应用于通常采集的 CT 扫描来计算冠状动脉压力和流量，从而对 CAD 进行生理评估，从而实现血流储备分数 (FFRCT)（血管特异性缺血的一种测量方法）的无创计算。该提案的总体假设是，将解剖学 APC 与生理学 FFRCT 相结合将优化对引起缺血的冠状动脉病变的识别。我们提出 3 个具体目标： 目标 1：通过 CT 评估解剖 APC 的性能，以诊断血管特异性缺血。目标 2：评估生理 FFRCT 诊断血管特异性缺血的性能。目标 3：直接比较综合解剖生理 (APC-FFRCT) CT 测量与 MPS 以诊断病变特异性缺血。该提案中的工作将为一种新的诊断范例提供理论依据，该范例比传统的应力成像测试更准确，可识别出现缺血的患者并查明导致缺血的冠状动脉病变；因此，可以更好地选择进行血运重建的个体并消除不必要的侵入性手术。