Noninvasive real-time intracardiac pressure measurements using subharmonic ultrasound

使用次谐波超声进行无创实时心内压测量

• 批准号: 9260041
• 负责人: Jaydev Dave
• 金额: $ 19.5万
• 依托单位: THOMAS JEFFERSON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-15 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9260041
• 关键词: Acoustics; Affect; Algorithms; American; Animals; Biopsy; Cardiac; Cardiac Catheterization Procedures; Cardiogenic Shock; Cardiovascular Diseases; Cardiovascular system; Catheterization; Catheters; Clinical; Clinical Management; Computer software; Contrast Media; Data; Diagnosis; Diastolic blood pressure; Diastolic heart failure; Echocardiography; Estimation Techniques; Evaluation; Feasibility Studies; Frequencies; Goals; Heart; Heart Transplantation; Heart failure; Hospitalization; Human; Hydrostatic Pressure; In Vitro; Investigation; Knowledge; Left; Measurement; Measures; Methods; Microbubbles; Monitor; Pathology; Patient Schedules; Patients; Pilot Projects; Population; Process; Pulmonary Capillary Wedge Pressure; Pulmonary artery structure; Recruitment Activity; Relaxation; Risk; Signal Transduction; Software Validation; Systolic Pressure; Techniques; Testing; Time; Treatment outcome; Ultrasonography; Variant; Ventricular; Work; analog; base; contrast enhanced; cost; experimental study; hemodynamics; improved; in vivo; innovation; intracardiac pressure; novel; pressure; public health relevance; quantum; radiofrequency; response; standard of care; tau Proteins; transmission process

 DESCRIPTION (provided by applicant): Echocardiographic techniques for the assessment of cardiac function have been limited by an inability to consistently measure intracardiac pressures noninvasively. If we can establish that insonation of contrast microbubbles and analysis of their subharmonic oscillations can accurately and continuously measure intracardiac pressures, many of the physical limitations of echocardiography would be overcome. Our group has demonstrated that the nonlinearly generated, subharmonic signal components from microbubble- based ultrasound contrast agents can provide an excellent indication of the hydrostatic pressure variation (from 0 to 200 mmHg). Based on these results, a quantitative technique called SubHarmonic-Aided Pressure Estimation (SHAPE) was proposed and investigated. SHAPE estimates internal pressure variations by transmitting at one frequency, but measuring signal response only at the subharmonic frequency. This technique has the potential to noninvasively measure changes in pressure and has been validated in animals. Our ongoing feasibility study provides proof-of-concept for SHAPE in humans. The fundamental hypothesis of this project is that intracardiac pressure changes in patients scheduled for a left and/or right heart catheterization can be measured using SHAPE in real-time and that results will compare favorably with catheter based pressure measurements. Thus, essential information regarding the functional integrity of the cardiovascular system can be provided noninvasively in real-time, which will fundamentally alter the clinical management of such patients. Initially, the SHAPE algorithm incorporating optimum incident acoustic pressure selection and processing of the subharmonic signals will be implemented on a state-of-the-art ultrasound scanner (SonixTablet, Analogic Corporation, Peabody, MA) for real-time SHAPE pressure measurements, which will be verified in vitro (Specific Aim 1). Next, we will study cardiac pressure changes in patients scheduled for a left and/or right heart catheterization using SHAPE and correlate results to catheter based pressure measurements and establish if the errors in pressure measurements using SHAPE are within 5 mmHg of the catheter-based pressure data (Specific Aim 2). Finally for a set of patients referred for clinically indicated left heart catheterization, we will compare the ventricular relaxation rate (peak isovolumic -dP/dt) and relaxation time constant (tau or τ) in addition to the clinically important ventricular systolic ad diastolic pressures obtained using SHAPE and high fidelity micromanometer-tipped catheters (Mikro-Cath, Millar, Inc. Houston, TX) (Specific Aim 3). In conclusion, this study aims to provide an improved and clinically useful, real-time implementation of the innovative SHAPE algorithm on a state-of- the-art, commercial ultrasound scanner and to challenge the clinical paradigm of invasively-determined, pressure measurements in patients scheduled for cardiac catheterization by noninvasively evaluating intracardiac pressures in humans.

 描述（由申请人提供）：用于评估心脏功能的超声心动图技术由于无法一致地无创地测量心内压力而受到限制。如果我们能够确定对比微泡的声波作用和对其次谐波振荡的分析可以准确、连续地测量心内压力，那么超声心动图的许多物理限制将被克服。我们的小组已经证明，基于微泡的超声造影剂产生的非线性分谐波信号分量可以很好地指示静水压变化（从 0 到 200 mmHg）。基于这些结果，提出并研究了一种称为次谐波辅助压力估计（SHAPE）的定量技术。 SHAPE 通过以一种频率传输来估计内部压力变化，但仅在分谐波频率下测量信号响应。该技术具有无创测量压力变化的潜力，并已在动物身上得到验证。我们正在进行的可行性研究为人类 SHAPE 提供了概念验证。该项目的基本假设是，可以使用 SHAPE 实时测量计划进行左心导管插入术和/或右心导管插入术的患者的心内压力变化，并且结果将与基于导管的压力测量相媲美。因此，可以实时无创地提供有关心血管系统功能完整性的重要信息，这将从根本上改变此类患者的临床管理。最初，结合最佳入射声压选择和分谐波信号处理的 SHAPE 算法将在最先进的超声扫描仪（SonixTablet，Analogic Corporation，Peabody，MA）上实施，以进行实时 SHAPE 压力测量，并将在体外进行验证（具体目标 1）。接下来，我们将使用 SHAPE 研究计划进行左心导管插入术和/或右心导管插入术的患者的心脏压力变化，并将结果与​​基于导管的压力测量相关联，并确定使用 SHAPE 的压力测量误差是否在基于导管的压力数据的 5 mmHg 以内（具体目标 2）。最后，对于临床上需要进行左心导管插入术的一组患者，除了使用 SHAPE 和高保真微压计尖端导管（Mikro-Cath，Millar，Inc. Houston，TX）获得的临床重要的心室收缩压和舒张压之外，我们还将比较心室舒张率（峰值等容 -dP/dt）和舒张时间常数（tau 或 τ）（具体目标 3）。总之，本研究旨在在最先进的商用超声扫描仪上提供一种改进的、临床上有用的创新 SHAPE 算法的实时实施，并通过无创评估人类心内压力，挑战对计划进行心导管插入术的患者进行有创测定压力测量的临床范例。

项目成果

Recent technological advancements in cardiac ultrasound imaging.

• DOI: 10.1016/j.ultras.2017.11.013
• 发表时间: 2018-03
• 期刊: Ultrasonics
• 影响因子: 4.2
• 作者: Dave JK;Mc Donald ME;Mehrotra P;Kohut AR;Eisenbrey JR;Forsberg F
• 通讯作者: Forsberg F

Developing an Interface and Investigating Optimal Parameters for Real-Time Intracardiac Subharmonic-Aided Pressure Estimation.

• DOI: 10.1109/tuffc.2020.3016264
• 发表时间: 2021-03
• 期刊: IEEE transactions on ultrasonics, ferroelectrics, and frequency control
• 作者: Esposito C;Dickie K;Forsberg F;Dave JK
• 通讯作者: Dave JK

Evaluation of Intracardiac Pressures Using Subharmonic-aided Pressure Estimation with Sonazoid Microbubbles.

使用 Sonazoid 微泡的次谐波辅助压力估计评估心内压力。

• DOI: 10.1148/ryct.230153
• 发表时间: 2024
• 期刊: Radiology. Cardiothoracic imaging
• 作者: Esposito,Cara;Machado,Priscilla;McDonald,MaureenE;Savage,MichaelP;Fischman,David;Mehrotra,Praveen;Cohen,IraS;Ruggiero2nd,Nicholas;Walinsky,Paul;Vishnevsky,Alec;Dickie,Kristopher;Davis,Marguerite;Forsberg,Flemming;Dave,Jaydev
• 通讯作者: Dave,Jaydev