Cardiac Magnetic Resonance IMaging During Arrhythmia

心律失常期间的心脏磁共振成像

• 批准号: 8882525
• 负责人: Aravindan Kolandaivelu
• 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: 2011-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8882525
• 关键词: Ablation; Affect; Arrhythmia; Atrial Fibrillation; Biomedical Engineering; Cardiac; Cardiac Electrophysiologic Techniques; Cardiac ablation; Cicatrix; Clinical; Clinical Research; Computer Simulation; Data Collection; EKG QRS Complex; Electrocardiogram; Electrophysiology (science); Environment; Fibrosis; Functional disorder; Future; Goals; Histology; Image; Imaging Techniques; Incidence; Institution; K-Series Research Career Programs; Lesion; Magnetic Resonance Imaging; Mechanics; Medical; Mentors; Morphology; Motion; Myocardial; Organ; Outcome; Patients; Procedures; Recording of previous events; Recovery; Recurrence; Research; Research Design; Research Ethics; Resistance; Resolution; Safety; Science; Scientist; Site; Speed; Structure; Techniques; Thermography; Time; Tissues; Training; Universities; Variant; Ventricular Arrhythmia; Ventricular Premature Complexes; Ventricular Tachycardia; Work; base; body system; cardiovascular visualization; career; career development; clinical application; heart motion; image guided therapy; improved; interest; medical schools; patient oriented research; programs; research and development; response

DESCRIPTION (provided by applicant): The aim of the career development and research strategies of this proposal are to build an independent clinician-scientist career focusing on: 1) reliable imaging of parameters that contribute to arrhythmia pathophysiology and ablation procedure outcome, 2) understanding how patient specific structural variations affect arrhythmia propagation and response to treatment, and 3) developing a cellular to organ system level understanding of arrhythmia pathophysiology, that will serve as a basis for future work. My background in clinical electrophysiology, imaging science, and computational modeling is well suited to the goal of improve arrhythmia treatment through individualized image guided therapy. My career development goals will be achieved through a combination of course work and mentored research at the Johns Hopkins University School of Medicine and Department of Biomedical Engineering. Johns Hopkins provides a stimulating research and clinical environment and has a long history of training leaders in patient-oriented research. The institution has a particular strength in studying the cellular to organ level aspects of cardiac electrophysiology and arrhythmia pathophysiology. The structured coursework portion of this career development program will include training in advanced topics in MRI research, image integrated computational modeling, clinical study design, and research ethics. The mentored research potion of this career development award will focus on cardiac magnetic resonance imaging (CMR) during arrhythmia. While many tachy-arrhythmias are curable by catheter ablation, some common conditions, in particular atrial fibrillation and ventricular tachycardia (VT), are sub-optimally managed by current medical and ablation treatments. Cardiac magnetic resonance imaging (CMR) is of increasing interest to cardiac electrophysiology because 1) CMR has the potential to visualize myocardial scar and fibrosis, which are important to VT and atrial fibrillation pathophysiology, and 2) CMR has the potential to visualize ablated tissue as well as gaps in intended regions of ablation. These gaps may not conduct acutely, so that the arrhythmia may not recur immediately after ablation, but the gaps can regain conduction over time. This recovery of conduction is likely a major mechanism for arrhythmia recurrence after ablation. The ability to visualize gaps with CMR, and eliminate those visualized gaps, would likely dramatically reduce the high incidence of VT and atrial fibrillation recurrence after ablation. Current high-resolution CMR techniques for imaging scar, fibrosis, and ablation lesions, however, are not reliable enough for routine clinical application. The proposed research will further develop techniques to perform more reliable high-resolution CMR during arrhythmia and will investigate related CMR applications of 1) predicting successful ablation sites by imaging regional wall motion during arrhythmia and 2) predicting ablation adequacy using arrhythmia resistant CMR thermography. The theme of this work is to provide more specific and individualized image guided therapy toward the goal of increasing the efficacy, speed, and safety of arrhythmia ablation procedures.

描述(申请人提供)：本建议的职业发展和研究策略的目标是建立一个独立的临床医生-科学家职业生涯，专注于：1)有助于心律失常病理生理学和消融手术结果的可靠参数成像，2)了解患者特定的结构变化如何影响心律失常的传播和治疗反应，以及3)发展对心律失常病理生理学的细胞到器官系统水平的了解，这将作为未来工作的基础。我在临床电生理学、成像科学和计算建模方面的背景非常适合通过个性化图像引导治疗来改善心律失常治疗的目标。我的职业发展目标将通过在约翰霍普金斯大学医学院和生物医学工程系的课程工作和指导研究相结合来实现。约翰霍普金斯大学提供了一个激动人心的研究和临床环境，并在培养以患者为中心的研究方面的领导者方面有着悠久的历史。该机构在心脏电生理学和心律失常病理生理学的细胞到器官层面的研究方面具有特别的优势。这一职业发展计划的结构化课程部分将包括MRI研究、图像集成计算建模、临床研究设计和研究伦理方面的高级主题培训。这个职业发展奖的指导研究药水将集中在心律失常期间的心脏磁共振成像(CMR)。虽然许多快速性心律失常可以通过导管消融来治愈，但一些常见的情况，特别是房颤和室性心动过速(VT)，在目前的医学和消融治疗中处于次优状态。心脏磁共振成像(CMR)对心脏电生理的研究越来越受到重视，因为1)CMR有可能显示心肌瘢痕和纤维化，这对室速和房颤的病理生理学很重要；2)CMR有可能显示消融组织和预期消融区域的间隙。这些间隙可能不会剧烈传导，因此心律失常在消融后可能不会立即复发，但随着时间的推移，这些间隙可以重新传导。这种传导的恢复可能是消融后心律失常复发的主要机制。CMR显示房间隔的能力，并消除这些可见的空隙，可能会显著降低消融后VT和心房颤动复发的高发生率。然而，目前用于成像瘢痕、纤维化和消融病变的高分辨率CMR技术对于常规的临床应用还不够可靠。这项拟议的研究将进一步开发在心律失常期间进行更可靠的高分辨率CMR的技术，并将研究相关的CMR应用：1)通过在心律失常期间成像局部室壁运动来预测成功的消融地点；2)使用抗心律失常的CMR热像预测消融充分性。这项工作的主题是提供更具体和个性化的影像引导治疗，以达到提高心律失常消融程序的有效性、速度和安全性的目标。