Anatomic and Physiologic Determinants of Vessel-Specific Ischemia by Coronary CT

冠状动脉 CT 血管特异性缺血的解剖学和生理学决定因素

• 批准号: 9313319
• 负责人: James K Min
• 金额: $ 50.61万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2019-05-06
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9313319
• 关键词: Adverse event; Agreement; Anatomy; Angiography; Arterial Fatty Streak; Atherosclerosis; Blood flow; Characteristics; Clinical; Companions; Comparative Study; Coronary; Coronary Angiography; Coronary Arteriosclerosis; Coronary artery; Data; Development; Diagnosis; Diagnostic; Echocardiography; Effectiveness; Evaluation; Future; Gold; Image; Imagery; Individual; Injury; International; Ischemia; Lesion; Liquid substance; Magnetic Resonance; Magnetic Resonance Imaging; Measures; Medical; Methods; Minority; Multicenter Studies; Myocardial; Myocardial Ischemia; Myocardial perfusion; Myocardium; Parents; Patients; Performance; Perfusion; Physiological; Procedures; Radionuclide Imaging; Research Personnel; Scanning; Stenosis; Stress; Stress Tests; Testing; Time; Work; X-Ray Computed Tomography; arterial remodeling; cost efficient; heart imaging; improved; novel; novel diagnostics; outcome forecast; pressure; prospective; public health relevance

DESCRIPTION (provided by applicant): The OVERALL OBJECTIVE of this proposal is to integrate the anatomic and physiologic information derived from computed tomographic angiograms for the precise identification of coronary artery lesions that cause ischemia. This proposal is a companion study to ISCHEMIA Trial. For patients with stable ischemic heart disease, myocardial ischemia may arise as a consequence of obstructive coronary artery disease (CAD) and is useful for guiding decisions of revascularization. To date, non-invasive stress tests have served as a mainstay for identifying ischemia; these tests include echocardiography, magnetic resonance and myocardial perfusion scintigraphy (MPS). Among these, MPS is performed most commonly due to its ability to identify obstructive CAD, reclassify CAD likelihood, and predict adverse events. CT has emerged as a non-invasive method that permits direct visualization of CAD, demonstrates high performance for obstructive CAD compared to invasive coronary angiography (ICA), and predicts adverse prognosis. Beyond stenosis, CT enables evaluation of additional atherosclerotic plaque characteristics (APCs) that demonstrate high agreement to invasive methods and may augment determination of coronary lesions that cause ischemia. Recent developments in CT also permit physiologic assessment of CAD by applying computational fluid dynamics to typically- acquired CT scans for calculation of coronary artery pressure and flow, thus enabling the non-invasive calculation of fractional flow reserve (FFRCT), a measure of vessel-specific ischemia. The OVERALL HYPOTHESIS of this proposal is that integrating anatomic APCs with physiologic FFRCT will optimize identification of coronary lesions that are ischemia-causing. We propose 3 specific aims: AIM 1: To assess performance of anatomic APCs by CT for diagnosis of vessel-specific ischemia. AIM 2: To assess performance of physiologic FFRCT for diagnosis of vessel-specific ischemia. AIM 3: To directly compare an integrated anatomic-physiologic (APC-FFRCT) CT measure to MPS for diagnosis of lesion-specific ischemia. The work in this proposal will provide the rationale for a novel diagnostic paradigm that is more accurate than conventional stress imaging testing for identifying patients who manifest ischemia and pinpointing the coronary lesions that are the cause; thus, allowing for better selection of individuals for revascularization and eliminating unnecessary invasive procedures.

描述（由申请人提供）：该提案的总体目的是整合从计算机断层造影血管造影的解剖学和生理信息，以精确鉴定引起缺血的冠状动脉病变。该提案是缺血试验的一项同伴研究。对于稳定的缺血性心脏病的患者，由于阻塞性冠状动脉疾病（CAD），可能会出现心肌缺血，并且对于指导血运重建的决定很有用。迄今为止，非侵入性压力测试已成为识别缺血的主要主体。这些测试包括超声心动图，磁共振和心肌灌注闪烁显像（MPS）。其中，MPS最常见的是由于其能够识别阻塞性CAD，重新分类CAD的可能性和预测不良事件的能力。与侵入性冠状动脉血管造影相比，CT已成为一种允许CAD直接可视化的非侵入性方法，证明了阻塞性CAD的高性能，并预测了不良预后。除狭窄外，CT还可以评估其他动脉粥样硬化斑块特征（APC），这些特征表明对侵入性方法表现出很高的一致性，并且可能会增强对引起缺血的冠状动脉病变的测定。 CT的最新发展还允许通过将计算流体动力学应用于通常获得的CT扫描来计算冠状动脉压力和流动的情况下进行生理评估，从而实现了分数流量储备（FFRCT）的非侵入性计算，这是一种容器特异性性性缺血的度量。该提案的总体假设是，将解剖APC与生理FFRCT相结合将优化鉴定引起缺血的冠状动脉病变。我们提出了3个具体目标：目标1：通过CT评估解剖APC的性能，以诊断血管特异性缺血。目标2：评估生理FFRCT的性能以诊断血管特异性缺血。 AIM 3：直接比较综合的解剖 - 生理学（APC-FFRCT）CT测量与MPS的诊断，以诊断病变特异性缺血。该提案中的工作将为一种新型诊断范式提供基本原理，该诊断范式比常规压力成像测试更准确，以识别表现出缺血的患者并确定其原因的冠状动脉病变；因此，允许更好地选择个体进行血运重建并消除不必要的侵入性程序。