4D Flow Cardiac Magnetic Resonance FOR Post Myocardial Infarction left ventricular thrombus

4D 血流心脏磁共振检查心肌梗死后左心室血栓

• 批准号: 9761241
• 负责人: Philip Angelo Corrado
• 金额: $ 3.33万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9761241
• 关键词: 3-Dimensional; 3D Print; 4D MRI; Acute myocardial infarction; Age; Aneurysm; Anticoagulation; Apical; Atrial Fibrillation; Blood; Blood Volume; Blood flow; Cardiac; Cardiovascular Diseases; Cardiovascular system; Characteristics; Chest; Clinical Data; Complex; Complication; Data; Data Set; Detection; Development; Event; Fostering; Functional disorder; Funding; Future; Gender; Goals; Gold; Heart Atrium; Heart Rate; Hemorrhage; Heterogeneity; Hybrids; Image; Image Analysis; Imaging Techniques; Impairment; In Vitro; Investigation; Kinetics; Lead; Left; Left Ventricular Ejection Fraction; Left ventricular structure; Link; Location; Magnetic Resonance; Magnetic Resonance Imaging; Measures; Mentors; Methods; Myocardial; Myocardial Infarction; Myocardial Reperfusion; Noise; Patient-Focused Outcomes; Patients; Pattern; Phase; Physics; Physiologic pulse; Physiological; Positioning Attribute; Printing; Problem Solving; Pulsatile Flow; Pump; Qualifying; Radial; Reference Standards; Request for Proposals; Research; Research Personnel; Residual state; Resolution; Risk; Scanning; Scheme; Stroke; Techniques; Testing; Thrombosis; Thrombus; Time; Training; Uncertainty; Validation; Velocimetries; Ventricular; Weight; Work; base; career; clinical care; cohort; high risk; image reconstruction; imaging approach; improved; improved outcome; in vivo; indexing; insight; interest; myocardial infarct sizing; novel; optical imaging; particle; skills; spatiotemporal; stem; tool; vector

Project Summary/Abstract Left ventricular thrombus (LVT) provides a substrate for embolic events and a rationale for anticoagulation. De- spite advances in coronary reperfusion, LVT remains common after ST elevation myocardial infarction (MI)– occurring in up to 1 in 5 patients with MI involving the LV apex. Predictors of LVT are limited, as evidenced by data that over half of cases occur without marked global LV dysfunction or aneurysm. Uncertainty as to who will develop LVT may explain clinical data that have shown anticoagulation to increase bleeding without decreasing stroke in seemingly at risk post-MI groups. Given the seriousness of stroke and bleeding conferred by LVT and its treatment, improved understanding of LVT is of major importance for the over quarter million people in the U.S. who sustain ST elevation MI each year. Cardiac magnetic resonance (CMR) imaging provides a highly accurate means to identify LVT, but current approaches are limited to predict in whom LVT will occur. This study is predicated on the hypothesis that LVT formation stems from altered LV blood flow and its determinants. To test this, LV blood flow will be quantified via volumetric time resolved “4D flow MRI” - a new method that can measure time-resolved, volumetric velocity vectors in vivo. We will develop a novel imaging approach for accurate assessment of LV flow impairment in in the context of MI. Aim 1 will develop new MRI methods that can be widely applied to quantify left ventricular stasis (low velocities). Specifically, a targeted 4D flow MRI pulse sequence (via radial stack-of-stars acquisition and dual velocity encoding) will be developed to achieve directed flow assessment of the LV with sensitivity to low velocities. Aim 2 will validate the new method: the new targeted acquisition will be compared with conventional full-chest acquisition for similarity to a reference standard (via optical imaging in vitro) or for repeatability in vivo. Aim 3 will test LV flow indices in a pilot cohort of MI patients to evaluate whether apical stasis (regional flow velocity, kinetic energy, residual blood volumes) post-MI is associated with LVT. The project sponsors and collaborators have a track record in successful translational CMR research and MRI physics, uniquely qualifying them to mentor on the proposed work. The novel information to be gained from this research has potential to impact clinical care by more precisely identifying post-MI flow patterns associated with LVT, thereby setting up future trials to test these parameters as predictors of LVT. The skills gained by the PI during this project will position him strongly for a successful independent research career in cardiovascular MRI.

项目摘要/摘要 左心室血栓(LVT)为栓塞性事件提供了底物，也为抗凝提供了理论基础。去- 尽管冠状动脉再灌注方面取得了进展，但ST段抬高心肌梗死(MI)后的LVT仍然很常见。 发生在多达1/5的心肌梗死患者累及左心室心尖部。LVT的预测因素是有限的，这一点就是证据 数据显示，超过一半的病例发生时没有明显的全身性左心功能障碍或动脉瘤。不确定谁将会 发展LVT可以解释临床数据显示抗凝可以增加出血而不是减少出血 急性心肌梗死后似乎有卒中危险的组。考虑到左心室肥厚导致中风和出血的严重性 它的治疗，提高对LVT的了解对本地区超过25万人具有重要意义 每年持续ST段抬高MI的美国人。心脏磁共振(CMR)成像提供了高度的 准确的手段来识别LVT，但目前的方法仅限于预测谁将发生LVT。本研究 是基于这样一种假设，即LVT的形成源于左心室血流及其决定因素的改变。至 测试这一点，左室血流将通过体积时间分辨率的“4D Flow MRI”-一种新的方法，可以 在活体内测量时间分辨的体积速度矢量。我们将开发一种新的成像方法来 在心肌梗死的情况下，准确评估左室血流的损害。AIM 1将开发新的MRI方法 可广泛应用于左心室停滞(低速)的量化。具体地说，有针对性的4D Flow MRI脉冲 将开发序列(通过径向星堆捕获和双速编码)以实现定向 对低速敏感的LV的流动评估。目标2将验证新方法：新的目标 采集将与传统的全胸采集进行比较，以获得与参考标准(VIA)的相似性 体外光学成像)或体内重复性。AIM 3将在心梗患者的先导队列中测试左室血流指数 评价心梗后心尖停滞(局部血流速度、动能、残血量)是否 与LVT相关。项目发起人和合作者在成功的翻译CMR方面有着良好的记录 研究和核磁共振物理，使他们有资格就拟议的工作提供指导。将新信息发送给 从这项研究中获得的BE可能会通过更准确地识别MI后的血流来影响临床护理 与LVT相关的模式，从而建立未来的试验，以测试这些参数作为LVT的预测因素。这个 PI在这个项目中获得的技能将为他成功的独立研究生涯奠定坚实的基础 在心血管核磁共振中。