MRI of Mechanical Activation and Scar for Optimal Cardiac Resynchronization Therapy Implementation

机械激活和疤痕的 MRI 用于最佳心脏再同步治疗的实施

• 批准号: 9544361
• 负责人: Kenneth C Bilchick
• 金额: $ 71.1万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9544361
• 关键词: Address; Anatomy; Area; Breathing; Bundle-Branch Block; Cardiac; Characteristics; Cicatrix; Clinical; Clinical Trials; Complement; Contracts; Data; Defibrillators; Development; Devices; Diagnosis; Dimensions; Disease; Equipoise; Evaluation; Financial compensation; Gadolinium; Generations; Goals; Guidelines; Health; Heart; Heart Diseases; Heart Valve Diseases; Heart failure; Hospitalization; Image; Image Analysis; Imaging Techniques; Implant; Individual; Intervention; Lead; Left; Left Ventricular Function; Life; Location; MRI Scans; Magnetic Resonance Imaging; Measurement; Measures; Mechanics; Methods; Mission; Morphologic artifacts; Motion; Myocardial Infarction; National Heart, Lung, and Blood Institute; Nature; Pacemakers; Patients; Performance; Positioning Attribute; Predictive Factor; Procedures; Protocols documentation; Pump; Randomized; Randomized Clinical Trials; Recovery; Reproducibility; Research; Research Personnel; Savings; Signal Transduction; Site; Structure of left gastric vein; Subgroup; System; Testing; To specify; United States; Ventricular; Ventricular End-Systolic Volumes; Width; base; cardiac resynchronization therapy; cardiovascular visualization; congenital heart disorder; contrast enhanced; data space; design; functional improvement; group intervention; heart disease risk; heart function; high resolution imaging; imaging modality; implantation; improved; improved outcome; novel; outcome forecast; programs; randomized trial; response; statistics; two-dimensional

Project Summary The overarching goal of this project is to use MRI guidance of cardiac resynchronization therapy (CRT) to improve outcomes for heart failure patients selected to undergo this procedure. The importance of using advanced cardiac imaging to make CRT more effective is highlighted by the following statistics: at least 5 million people in the United States have heart failure, 2.5 million require hospitalization, and more than 500,000 are diagnosed with heart failure each year. As a result, this research is highly aligned with the mission of the National Heart, Lung, and Blood Institute to enhance the health of individuals with heart disease or at risk for heart disease so they can live longer and more fulfilling lives. Over the past decade, CRT has emerged as a highly beneficial treatment for many patients with heart failure. CRT involves implantation of an advanced pacemaker/defibrillator attached to three wires in the heart designed to make unevenly pumping hearts contract more synchronously and effectively. Unfortunately, 35-50% of patients do not have improved heart function after CRT, often because of suboptimal positioning of the pacing wires with respect to scar and mechanical activation. In this regard, we have previously demonstrated how MRI strain imaging with the DENSE (Displacement Encoding with Stimulated Echoes) method and contrast-enhanced MRI assessment of scar and coronary veins in the heart can identify the optimal location of the left ventricular CRT pacing site relative to scar and mechanical activation. As a result, there is clinical equipoise for a systematic evaluation with a randomized clinical trial of CRT guided by cardiac MRI for assessment of mechanical activation, scar, and coronary vein anatomy in the heart in order to improve outcomes after CRT. We will randomize 105 patients in a 1:1 ratio, and the primary endpoint will be improvement of left ventricular function as measured by the percent reduction in the left ventricular end systolic volume 6 months after CRT implantation. In the project, we will further refine DENSE strain imaging by improving both three-dimensional and multislice two-dimensional imaging during free breathing by employing imaging-based and projection-based “navigators.” This is very important because breathing during conventional imaging leads to artifacts in the images, and a significant number of patients with heart disease and heart failure have difficulty holding their breath. In addition, there are an increasing number of CRT pacing settings, and the project also addresses an unmet need for evaluation of the optimal CRT pacing strategy using reproducible assessments of cardiac functional improvement with cardiac MRI to complement echocardiographic assessments. In addition to the application of these methods in CRT, we also emphasize that the improved MRI methods have potential far- reaching applications for other patients with myocardial infarction, valvular heart disease, congenital heart disease, and other types of heart disease. 1

项目摘要 该项目的总体目标是使用心脏再同步治疗(CRT)的MRI指导 改善心力衰竭患者选择接受这一手术的结果。使用的重要性 以下统计数据突显了使CRT更有效的先进心脏成像：至少500万 在美国，有250万人患有心力衰竭，250万人需要住院治疗，超过50万人患有心力衰竭 每年都被诊断出心力衰竭。因此，这项研究与国家统计局的使命高度一致 心肺和血液研究所，以增进心脏病患者或有心脏病风险的个人的健康 这样他们就能活得更长、更有成就感。在过去的十年中，CRT已经成为一种非常有益的 治疗许多心力衰竭患者。CRT涉及植入先进的起搏器/除颤器 连接在心脏上的三根电线，旨在使泵血不均匀的心脏更同步地收缩 而且是有效的。不幸的是，35-50%的患者在CRT后心功能没有改善，通常是因为 相对于疤痕和机械激活，起搏钢丝的位置不佳。在这方面，我们 以前曾演示过如何在密集(位移编码与激励)情况下进行MRI应变成像 心脏瘢痕和冠状静脉的回声)方法和增强MRI评估可以识别 与瘢痕和机械激活相关的左心室CRT起搏位置的最佳位置。结果, 心脏导引下CRT的随机临床试验具有系统评价的临床条件 MRI对心脏机械激活、瘢痕和冠状静脉解剖的评估以改善 CRT术后转归。我们将以1：1的比例随机抽取105名患者，主要终点将是改善 以左室收缩末期容量减少的百分比来衡量左心功能。 CRT植入后几个月。在该项目中，我们将通过改进两种方法来进一步优化密集应变成像 基于成像的自由呼吸三维和多层二维成像 以及基于投影的“导航器”。这一点非常重要，因为常规成像过程中的呼吸导联 图像中的伪影，相当数量的心脏病和心力衰竭患者有困难 屏住呼吸。此外，还有越来越多的CRT调搏设置，该项目还 使用可重复的评估解决未满足的评估最佳CRT起搏策略的需求 心脏MRI可改善心功能，以补充超声心动图评估。除了……之外 介绍了这些方法在CRT中的应用，强调了改进后的MRI方法在CRT中的应用前景。 适用于其他心肌梗塞、瓣膜病、先天性心脏病患者 疾病，以及其他类型的心脏病。 1