Applications of Magnetic Resonance for Management of Ventricular Tachycardia

磁共振在室性心动过速治疗中的应用

• 批准号: 8611808
• 负责人: Saman Nazarian
• 金额: $ 13.99万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-03-02 至 2016-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8611808
• 关键词: Ablation; Accounting; Address; Anatomy; Arrhythmia; Biometry; Cardiac; Cardiac ablation; Cardiomyopathies; Characteristics; Cicatrix; Clinical; Clinical Research; Defect; Defibrillators; Detection; Development; Development Plans; Diagnosis; Disease; Effectiveness; Electrocardiogram; Electrophysiology (science); Enrollment; Epidemiologic Studies; Epidemiology; Evaluation; Failure; Fellowship; Fibrosis; Fluoroscopy; Freedom; Heart; Image; Imagery; Imaging Techniques; Implantable Defibrillators; Laboratories; Left Ventricular Dysfunction; Lesion; Location; Logistic Regressions; Magnetic Resonance; Magnetic Resonance Imaging; Maintenance; Maps; Measures; Mediating; Medical Imaging; Mentors; Mentorship; Methodology; Molecular; Morphology; Muscle; Myocardial; Myocardium; Myotonic Dystrophy; Neurology; Noise; Outcome; Outcomes Research; Pacemakers; Pain; Pathway interactions; Patients; Pattern; Performance; Physiological; Population; Population Study; Procedures; Prospective Studies; Public Health; Public Health Schools; Quality of life; Randomized; Refractory; Research; Research Design; Research Proposals; Resources; Risk; Risk Marker; Safety; Services; Shapes; Shock; Signal Transduction; Site; Stratification; Study of magnetics; Sudden Death; Syncope; System; Tachycardia; Tail; Techniques; Technology; Testing; Therapeutic; Time; Tissues; Training; Translations; United States; Ventricular; Ventricular Arrhythmia; Ventricular Tachycardia; Work; abstracting; base; career development; clinical epidemiology; design; effective therapy; experience; genetic analysis; high risk; improved; injured; interest; member; mortality; novel; patient oriented research; primary outcome; programs; public health relevance; research and development; secondary outcome; success; sudden cardiac death; technology development; tool

DESCRIPTION (provided by applicant): I am interested in clinical translation of new methodologies for risk stratification and therapy of patients with ventricular tachycardia (VT). My proposed career development plan incorporates patient-oriented research guided by the mentorship of Dr. Henry R. Halperin, with a doctoral program in clinical epidemiology under the mentorship of Dr. Neil R. Powe. Dr. Halperin has extensive experience in technology development for magnetic resonance imaging (MRI) guided electrophysiology. As a member of Dr. Halperin's laboratory during fellowship, I used myocardial scar imaging and characterization techniques for identification of the substrate for inducible VT in patients with non-ischemic cardiomyopathy. This technique has since been validated by other groups, and was later shown to identify non-ischemic cardiomyopathy patients at high risk of sudden death. However, the benefits of such an approach remain unassessed in many other high-risk patient subsets. Even upon identification of high-risk patients, current treatments for VT are not ideal. Implantable defibrillators cause painful shocks and decrease quality of life, and catheter ablation is associated with failures deriving from the inability to visualize the VT substrate with fluoroscopy. The central hypothesis of this proposal is that scar (substrate) visualization via MRI can improve the risk stratification and therapy of VT. The aims of my research proposal are to 1) Examine the utility of MRI for detection of the VT substrate in another high risk population and 2) Examine the efficacy of pre-acquired three-dimensional MRI scar map integration for substrate based VT ablation versus standard VT ablation. Importantly, the clinical focus of my aims is complementary, but distinct, from Dr. Halperin's focus on technology development. Successful clinical translation of such technology will require comprehensive study of the functional electrophysiology correlates of various scar morphologies on imaging, and assessment of effectiveness and safety outcomes. The necessity of successful clinical translation of our technologic advances has shaped my career development and research aims and will help me achieve investigative independence. To properly address these aims we will require sophisticated epidemiologic, study design, and biostatistical techniques. To this end, I have enrolled in the doctoral clinical epidemiology program at the Johns Hopkins Bloomberg School of Public Health. Dr. Powe, an expert in epidemiology and outcomes research, will oversee my training in clinical epidemiology. My other mentor, Dr. Brian S. Caffo is an expert in biostatistics and medical imaging. Translation of new methodologies for risk stratification and treatment of patients with ventricular arrhythmia has the potential to impact public health significantly. I look forward to the opportunity to contribute to this important research while developing expertise and investigative independence in clinical research, through the resources of this proposal. PUBLIC HEALTH RELEVANCE: The aim of this proposal is to enhance the career development of the candidate through: 1) a didactic doctoral program in clinical epidemiology and 2) patient oriented research in magnetic resonance imaging techniques for risk stratification and catheter ablation of ventricular tachycardia. It is estimated that sudden cardiac death accounts for up to 15 percent of the total mortality in the United States. Translation of new methodologies for risk stratification and treatment of ventricular arrhythmia may allow earlier recognition and more effective treatment for patients at high risk of sudden death, and has the potential to impact public health significantly. (End of Abstract)

描述（由申请人提供）：我对室性心动过速（VT）患者风险分层和治疗的新方法的临床转化感兴趣。我提出的职业发展计划包括在 Henry R. Halperin 博士的指导下以患者为导向的研究，以及在 Neil R. Powe 博士的指导下的临床流行病学博士课程。 Halperin 博士在磁共振成像 (MRI) 引导的电生理学技术开发方面拥有丰富的经验。在进修期间，作为 Halperin 博士实验室的成员，我使用心肌疤痕成像和表征技术来识别非缺血性心肌病患者诱导性 VT 的底物。此技术后来得到了其他小组的验证，后来被证明可以识别猝死高风险的非缺血性心肌病患者。然而，这种方法的好处在许多其他高风险患者亚群中仍未得到评估。即使识别出高危患者，目前的 VT 治疗方法也并不理想。植入式除颤器会导致痛苦的电击并降低生活质量，而导管消融则与无法通过荧光镜观察 VT 基底而导致的失败有关。该提案的中心假设是通过 MRI 实现疤痕（基质）可视化可以改善 VT 的风险分层和治疗。我的研究提案的目的是 1) 检查 MRI 在检测另一高危人群中 VT 基质的效用，以及 2) 检查预先获得的三维 MRI 疤痕图集成对于基于基质的 VT 消融与标准 VT 消融的功效。重要的是，我的目标的临床重点与 Halperin 博士对技术开发的重点是互补的，但又不同。此类技术的成功临床转化将需要全面研究与成像上的各种疤痕形态相关的功能性电生理学，并评估有效性和安全性结果。我们的技术进步成功临床转化的必要性塑造了我的职业发展和研究目标，并将帮助我实现研究独立性。为了正确实现这些目标，我们需要复杂的流行病学、研究设计和生物统计技术。为此，我报名参加了约翰·霍普金斯大学布隆伯格公共卫生学院的临床流行病学博士项目。鲍威博士是流行病学和结果研究方面的专家，他将监督我在临床流行病学方面的培训。我的另一位导师 Brian S. Caffo 博士是生物统计学和医学成像方面的专家。室性心律失常患者风险分层和治疗的新方法的转化有可能对公众健康产生重大影响。我期待有机会通过本提案的资源为这项重要的研究做出贡献，同时发展临床研究的专业知识和调查独立性。 公共卫生相关性： 该提案的目的是通过以下方式促进候选人的职业发展：1）临床流行病学的教学博士课程和2）以患者为导向的磁共振成像技术研究，用于室性心动过速的风险分层和导管消融。据估计，心源性猝死占美国总死亡率的 15%。室性心律失常风险分层和治疗的新方法的转化可能有助于对猝死高风险患者进行更早的识别和更有效的治疗，并有可能对公共健康产生重大影响。 （摘要完）

项目成果

Feasibility of using patient-specific models and the "minimum cut" algorithm to predict optimal ablation targets for left atrial flutter.

• DOI: 10.1016/j.hrthm.2016.04.009
• 发表时间: 2016-08
• 期刊: Heart rhythm
• 影响因子: 5.5
• 作者: Zahid S;Whyte KN;Schwarz EL;Blake RC 3rd;Boyle PM;Chrispin J;Prakosa A;Ipek EG;Pashakhanloo F;Halperin HR;Calkins H;Berger RD;Nazarian S;Trayanova NA
• 通讯作者: Trayanova NA

The association of pre-existing left atrial fibrosis with clinical variables in patients referred for catheter ablation of atrial fibrillation.

• DOI: 10.4137/cmc.s15036
• 发表时间: 2014
• 期刊: Clinical Medicine Insights. Cardiology
• 作者: Dewire J;Khurram IM;Pashakhanloo F;Spragg D;Marine JE;Berger RD;Ashikaga H;Rickard J;Zimmerman SL;Zipunnikov V;Calkins H;Nazarian S
• 通讯作者: Nazarian S

The association of left atrial low-voltage regions on electroanatomic mapping with low attenuation regions on cardiac computed tomography perfusion imaging in patients with atrial fibrillation.

• DOI: 10.1016/j.hrthm.2015.01.015
• 发表时间: 2015-05
• 期刊: HEART RHYTHM
• 影响因子: 5.5
• 作者: Ling, Zhiyu;McManigle, John;Zipunnikov, Vadim;Pashakhanloo, Farhad;Khurram, Irfan M.;Zimmerman, Stefan L.;Philips, Binu;Marine, Joseph E.;Spragg, David D.;Ashikaga, Hiroshi;Calkins, Hugh;Nazarian, Saman
• 通讯作者: Nazarian, Saman

Is ventricular arrhythmia a possible mediator of the association between aortic stenosis-related midwall fibrosis and mortality?

室性心律失常是否是主动脉瓣狭窄相关的中壁纤维化与死亡率之间关联的可能中介因素？

• DOI: 10.1016/j.jacc.2011.04.045
• 发表时间: 2011
• 期刊: Journal of the American College of Cardiology
• 影响因子: 24
• 作者: Nazarian,Saman

Left Atrial LGE and Arrhythmia Recurrence Following Pulmonary Vein Isolation for Paroxysmal and Persistent AF.

• DOI: 10.1016/j.jcmg.2015.10.015
• 发表时间: 2016-02
• 期刊: JACC. Cardiovascular imaging
• 作者: Khurram IM;Habibi M;Gucuk Ipek E;Chrispin J;Yang E;Fukumoto K;Dewire J;Spragg DD;Marine JE;Berger RD;Ashikaga H;Rickard J;Zhang Y;Zipunnikov V;Zimmerman SL;Calkins H;Nazarian S
• 通讯作者: Nazarian S