4D ventricle-valve model risk stratification for planning surgical treatment of ischemic mitral regurgitation

4D 心室瓣膜模型风险分层用于规划缺血性二尖瓣反流的手术治疗

• 批准号: 9754718
• 负责人: Ahmed Aly
• 金额: $ 3.21万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-01 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9754718
• 关键词: 3-Dimensional; Affect; Age; Algorithms; American; Anatomic Models; Anatomy; Atlases; Biological Markers; Cardiac; Clinical; Collaborations; Computational algorithm; Data Set; Disease; Failure; Functional disorder; Goals; Image; Image Analysis; Incidence; Label; Left; Left Ventricular Remodeling; Left ventricular structure; Machine Learning; Manuals; Measurement; Medial; Mentors; Mitral Valve; Mitral Valve Insufficiency; Modeling; Motion; Myocardial Infarction; Operating Rooms; Operative Surgical Procedures; Outcome; Output; Partner in relationship; Patients; Plant Roots; Population; Predictive Value; Procedures; Recurrence; Reproducibility; Research; Risk stratification; Series; Severities; Shapes; Structure; Subgroup; Surgeon; Survival Rate; Technology; Testing; Three-dimensional analysis; Time; Transesophageal Echocardiography; Translating; Ventricular; aging population; case-by-case basis; clinically translatable; experience; high risk; imaging Segmentation; imaging biomarker; improved; improved outcome; individual patient; morphometry; mortality; muscular structure; papillary muscle; randomized trial; repaired; tool; treatment strategy; valve replacement; virtual

Project Summary/Abstract Ischemic mitral regurgitation (IMR) is a disease where the normal mitral valve (MV) structure is dysfunctional due to left ventricular (LV) remodeling after a myocardial infarction (MI). IMR affects nearly 3 million Americans and the magnitude of this problem is expected to grow as the population ages. IMR has a substantial mortality rate that is associated with even mild MR severity. Mitral valve repair with undersized ring annuloplasty has been the preferred treatment strategy for IMR; however, the recurrence of moderate or severe IMR within 12 months of surgery is common. Recent high profile results from the Cardiothoracic Surgical Trials Network (CTSN) mul- ticenter randomized trials on IMR have confirmed a high incidence of early recurrent IMR. More importantly, these studies highlighted the adverse impact of recurrent IMR on LV remodeling and clinical outcomes. The CTSN trials demonstrated no significant difference in LV volume reduction or survival at 12 and 24 months between repair and replacement groups; however, subgroup analysis demonstrated that repair patients that developed recurrent IMR had no reduction in LV volume while repair patients without recurrence experienced LV volume reduction that was superior to patients having valve replacement. The results of the CTSN IMR trials indicate an unmet need for a pre-operative risk stratification tool that reliably predicts MV repair failure. Such a tool would significantly reduce the problem of recurrent IMR by performing valve repair only in patients likely to experience a durable result and performing valve replacement in patients with high risk of recurrence. The long term goal is to improve quality of surgical therapy in IMR by improving risk-stratification pre-operatively using image analysis tools. The overall objective of this proposal is to improve the prediction IMR recurrence by ex- panding this model to include the left ventricle (LV). The rationale is that while IMR manifests as MV malcoapta- tion, the root cause of the disease is LV remodeling. The central hypothesis is that features extracted from the integrated left ventricular and mitral valve (LVMV) model will predict recurrence more accurately than the current MV-only model. To fulfill this objective and test the central hypothesis by pursuing the following specific aims: 1) Develop the 4D integrated LVMV model and compare the accuracy of fitting this model to intraoperative 3DTE images to that of the existing MV-only model. 2) Assess the ability of biomarkers derived from the integrated LVMV model to predict IMR recurrence, and compare to the predictive value of the MV-only model. The project is significant because, if successful, the integrated LVMV model will be incorporated into the Gorman lab ongoing effort translating this technology to the operating room, thus improving survival rates, reducing the impending clinical burden and the number of repeated procedures.

项目总结/摘要 缺血性二尖瓣返流（IMR）是一种正常二尖瓣（MV）结构功能障碍的疾病 由于心肌梗死（MI）后左心室（LV）重塑。IMR影响近300万美国人 随着人口老龄化，这一问题的严重性预计会增加。IMR的死亡率很高 与轻度二尖瓣返流严重程度相关的比率。使用尺寸过小的瓣环成形术进行二尖瓣修复， IMR的首选治疗策略;然而，12个月内中度或重度IMR的复发 手术是常见的。心胸外科试验网络（CTSN）穆尔的最新高调结果- 关于IMR的中心随机试验已经证实早期复发IMR的发生率很高。更重要的是， 这些研究强调了复发性IMR对LV重构和临床结果的不利影响。的 CTSN试验表明，在12个月和24个月时，LV减容或生存率无显著差异 然而，亚组分析表明， 发生复发性IMR的患者左心室容积没有减少，而修复患者没有复发 LV减容上级优于瓣膜置换术患者。CTSN IMR试验的结果 表明对可靠预测MV修复失败的术前风险分层工具的需求未得到满足。这样的 该工具将通过仅在可能存在以下情况的患者中进行瓣膜修复术， 在复发风险高的患者中进行瓣膜置换术。长 长期目标是通过改善术前风险分层来提高IMR的手术治疗质量， 图像分析工具。本提案的总体目标是通过以下方式改善IMR复发的预测： 扩展该模型以包括左心室（LV）。基本原理是，虽然IMR表现为MV malcoapta- 这种疾病的根本原因是LV重构。核心假设是，从图像中提取的特征 集成左心室和二尖瓣（LVMV）模型将比目前更准确地预测复发 mv模型为了实现这一目标，并通过追求以下具体目标来检验中心假设：1） 开发4D集成LVMV模型，并比较该模型与术中3DTE拟合的准确性 图像到现有的MV仅模型。2)评估生物标志物的能力， LVMV模型预测IMR复发，并与仅MV模型的预测值进行比较。项目 如果成功，集成的LVMV模型将被纳入戈尔曼实验室， 努力将这项技术转化为手术室，从而提高生存率，减少即将发生的 临床负担和重复手术次数。