VIRTUAL TOOLS FOR CARDIAC VENTRICULAR REMODELING SURGERY

心室重构手术的虚拟工具

• 批准号: 8721475
• 负责人: Julius Matteo Guccione
• 金额: $ 36.65万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-04-15 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8721475
• 关键词: 3-Dimensional; Address; Aftercare; American; Aneurysm; Animals; Attention; Books; Cardiac; Cardiac Catheterization Procedures; Cardiology; Cardiovascular Diseases; Cardiovascular system; Clinical; Communities; Computing Methodologies; Country; Data; Depressed mood; Devices; Diagnosis; Diastolic blood pressure; Diffusion Magnetic Resonance Imaging; Disease; Elements; Engineering; Evaluation; Fiber; Funding; Geometry; Goals; Heart; Heart Transplantation; Heart failure; Hour; Human; Infarction; Lead; Left; Left Ventricular Function; Left Ventricular Remodeling; Longevity; Magnetic Resonance Imaging; Measurement; Measures; Mechanics; Medical; Mental Depression; Methodology; Methods; Modeling; Motion; Myocardial; Myocardial Infarction; Myocardial Ischemia; Myocardium; Operative Surgical Procedures; Patient Care; Patients; Physics; Physiologic intraventricular pressure; Physiological; Preparation; Procedures; Process; Property; Protocols documentation; Quality of life; Relative (related person); Research; Sheep; Skin; Software Tools; Specific qualifier value; Stress; Stroke Volume; Sturnus vulgaris; Surface; Surgeon; Therapeutic Intervention; Time; Tissues; United States National Institutes of Health; Ventricular; Ventricular Aneurysm; Ventricular Remodeling; Virtual Tool; abstracting; base; clinical application; clinically relevant; design; effective therapy; human subject; improved; in vivo; insight; novel; palliation; pressure; prevent; repaired; response; restoration; tool

7. Project Summary/Abstract There are currently 5 million Americans with diagnosed heart failure (HF), and 550,000 new cases every year. The majority of HF cases is now the result of myocardial infarction (MI)-induced left ventricular (LV) remodeling. The lack of a well-established effective treatment has lead to a continually expanding list of medical and surgical options for the palliation of HF patients. Using our Myocardial Material Property Software Tool (MMPST; developed and validated during the initial funding period) and an ovine model of MI, we have provided cardiologists and cardiac surgeons with new insights into the mechanism of MI-induced HF by focusing their attention on changes that occur in the normally perfused myocardium immediately adjacent to the MI (the borderzone). Our MMPST demonstrates that borderzone (BZ) myocardial contractility is substantially reduced in comparison to that in LV regions remote from the MI. The overall goals of the proposed research are to validate clinical application of our MMPST and demonstrate a strong clinical correlation between regional myocardial contractility and disease state. There are five specific aims: (1) Using our MMPST, measure in-vivo regional myocardial contractility in patients before heart transplantation; (2) Measure ex-vivo regional myocardial contractility in skinned fiber preparation obtained from the hearts studied in Aim #1. We will use these direct active force measurements to validate clinical application of our MMPST; (3) Using diffusion MRI (dMRI), measure ex-vivo regional myofiber orientation in the hearts studied in Aim #1, as well as in normal human hearts and human hearts with an MI. If these clinically relevant measurements are not significantly different (as we previously discovered in normal versus infarcted sheep hearts), then clinical application of our MMPST does not require in-vivo dMRI; (4) Measure in-vivo regional myocardial contractility in patients after MI and compare BZ contractility with that in remote LV regions. If these clinical measurements also demonstrate significantly depressed BZ contractility, then procedures designed to restore a more normal LV geometry late in the remodeling process may be ineffective (as we also discovered in sheep with repaired LV aneurysm); (5) Measure in-vivo regional myocardial contractility in normal human subjects and compare these measurements with those obtained in Aim #1 and Aim #4. If these clinical measurements can be correlated to disease state and the potential effect of therapeutic intervention, then the cardiology community will be able to add a significant new methodology to its armamentarium regarding patient care protocols.

7.项目总结/摘要 目前有500万美国人被诊断患有心力衰竭（HF），每年有55万新病例。 现在大多数HF病例是心肌梗死（MI）诱导的左心室（LV）的结果 重塑由于缺乏一种行之有效的治疗方法， 缓解HF患者的医疗和手术选择。使用我们的心肌材料属性软件 工具（MMPST;在初始资助期间开发和验证）和MI的绵羊模型，我们有 为心脏病学家和心脏外科医生提供了MI诱导HF机制的新见解， 将他们的注意力集中在紧邻的正常灌注心肌中发生的变化， 边境地带（The Borderzone）我们的MMPST表明，边界区（BZ）心肌收缩力是 与远离MI的LV区域相比显著降低。的总体目标 拟议的研究是为了验证我们的MMPST的临床应用，并证明一个强大的临床 局部心肌收缩力与疾病状态的相关性。具体目标有五个：（1）利用 我们的MMPST，测量心脏移植前患者体内局部心肌收缩力;（2） 测量从所研究的心脏获得的带皮纤维制备物中的离体局部心肌收缩力 目标#1。我们将使用这些直接的主动力测量来验证我们的MMPST的临床应用; (3)使用扩散MRI（dMRI），测量目标1中研究的心脏中的离体局部肌纤维方向， 以及在正常人心脏和患有MI的人心脏中。如果这些临床相关测量结果 没有显著差异（正如我们先前在正常与梗死羊心脏中发现的那样）， 我们的MMPST的应用不需要体内dMRI;（4）测量体内局部心肌收缩力 并比较BZ与远端LV区域的收缩力。如果这些临床测量 也表现出显着降低BZ收缩性，然后程序旨在恢复一个更正常的 在重塑过程的后期，LV几何形状可能无效（正如我们在绵羊中发现的那样， LV动脉瘤）;（5）测量正常人受试者体内局部心肌收缩力，并比较 这些测量结果与目标#1和目标#4中获得的测量结果一致。如果这些临床测量可以 与疾病状态和治疗干预的潜在效果相关，然后心脏病学界 将能够增加一个重要的新方法，其医疗设备有关病人护理协议。