An Accurate Non-Contrast-Enhanced Cardiac MRI Method for Imaging Chronic Myocardial Infarctions: Technical Developments to Rapid Clinical Validation

用于慢性心肌梗塞成像的准确非增强心脏 MRI 方法：快速临床验证的技术发展

• 批准号: 9899302
• 负责人: Debiao Li
• 金额: $ 86.85万
• 依托单位: CEDARS-SINAI MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9899302
• 关键词: 3-Dimensional; American; American Heart Association; Animal Model; Arrhythmia; Attention; Autopsy; Biophysics; Brain; Breathing; Cardiac; Caring; Cessation of life; Characteristics; Chronic; Chronic Kidney Failure; Clinical; Collagen; Communities; Contrast Media; Coronary; Data; Data Set; Deposition; Detection; Development; Devices; Diagnosis; Epidemic; Etiology; Face; Gadolinium; Gold; Guidelines; Heart; Heart Diseases; Heart failure; Image; Infarction; Infusion procedures; Kidney Failure; Knowledge; Lead; Location; Magnetic Resonance Imaging; Medical; Methods; Morbidity - disease rate; Morphologic artifacts; Motion; Myocardial; Myocardial Infarction; Myocardial Ischemia; Myocardium; Noise; Operative Surgical Procedures; Pathologic; Patients; Population; Preparation; Recovery; Research; Risk; Safety; Sample Size; Scanning; Signal Transduction; Survival Rate; Testing; Therapeutic; Time; Translating; Validation; Visual; acute care; base; clinical practice; comorbidity; contrast imaging; cost; experience; imaging approach; imaging modality; improved; information gathering; mortality; non-invasive imaging; patient population; patient safety; success; trend

PROJECT SUMMARY Major advances in acute care have now reversed the trend of immediate death from myocardial infarction (MI). However, the long-term morbidity, particularly from heart failure, in these patients has become an epidemic. Currently, ~ 1 in 60 Americans carry a diagnosis of heart failure and face a grim 5-year survival rate (<50%). The therapeutic options available to these patients (medical, surgical and/or device-based) require knowledge of presence of prior (chronic) infarction(s) and its characteristics (location, size and transmurality). American Heart Association guidelines recommend late-enhancement (LGE) cardiac MRI for gathering this information. In spite of its capabilities, LGE cardiac MRI (CMR) has a key limitation – it requires infusion of gadolinium- based contrast agents, which are toxic to patients with late stage chronic kidney disease (CKD). Given the comorbidity of CKD in patients with heart disease, LGE CMR is contraindicated in at least 20% of all heart failure patients (at least 1 million in the US). Importantly, late stage CKD patients who cannot undergo LGE CMR are in great need of chronic MI assessment since the risk of cardiac mortality is substantially elevated in this population. Moreover, multiple, recent, autopsy studies in subjects without CKD who had undergone gadolinium-enhanced MRI studies years before death have found gadolinium (Gd) deposits in the brain. This has led to even greater concern in the imaging community regarding gadolinium use. Thus, there is an unmet and growing need for accurate assessment of chronic MI without contrast agents. Multiple efforts have been made in detecting and characterizing chronic MI without contrast agents using CMR. Although these methods have made significant headway, they have not translated into clinical practice because of limitations in image artifacts, long imaging times, patient safety and inadequate image contrast-to- noise ratio. Importantly, methods that could be safe, performed within reasonable imaging time and yield artifact-free images had an order of magnitude lower CNR than LGE. We propose to develop and validate a CMR approach that is time efficient, will lead to little to no image artifacts and safe. This imaging approach is expected to enable imaging of chronic MIs as well as LGE CMR within the same time it takes to perform LGE CMR in a wide-range of MI patients without contrast agents. Importantly, the proposed non-contrast CMR method has the potential to improve the care for a large segment of heart failure patients, who are currently without a viable option as they are contraindicated for LGE CMR.

项目摘要 急性护理的重大进展现已扭转了心肌梗死（MI）立即死亡的趋势。 然而，这些患者的长期发病率，特别是心力衰竭，已成为一种流行病。 目前，60名美国人中约有1人被诊断为心力衰竭，并面临严峻的5年生存率（<50%）。 这些患者可用的治疗选择（内科、外科和/或基于器械）需要了解 存在既往（慢性）梗死及其特征（位置、大小和透壁性）。美国 心脏协会指南建议使用晚期增强（LGE）心脏MRI来收集这些信息。 尽管LGE心脏MRI（CMR）功能强大，但它有一个关键的限制-它需要注入钆- 基于造影剂，对晚期慢性肾病（CKD）患者有毒。鉴于 心脏病患者中CKD的合并症，至少20%的心脏病患者禁用LGE CMR 失败患者（美国至少有100万）。重要的是，不能接受LGE的晚期CKD患者 CMR非常需要慢性MI评估，因为心脏死亡的风险大大增加， 这个人口。此外，最近在没有CKD的受试者中进行的多项尸检研究表明， 死亡前几年的钆增强MRI研究发现脑中有钆（Gd）沉积。这 已经导致成像界对钆的使用更加关注。因此，有一个未满足的 以及对在没有造影剂的情况下准确评估慢性MI的需求日益增长。 已经在使用造影剂检测和表征慢性MI而不使用造影剂方面做出了多种努力， CMR。尽管这些方法取得了重大进展，但尚未转化为临床实践 由于图像伪影的限制、长成像时间、患者安全性和图像对比度不足， 噪声比重要的是，方法可能是安全的，在合理的成像时间和产量内进行 无伪影图像的CNR比LGE低一个数量级。 我们建议开发和验证CMR方法，该方法具有时间效率，将导致很少或没有图像 文物和安全。这种成像方法有望实现慢性MI以及LGE CMR的成像 在没有造影剂的情况下，在广泛的MI患者中进行LGE CMR所需的相同时间内。 重要的是，所提出的非对比CMR方法有可能改善对大片段的护理 心力衰竭患者，目前没有可行的选择，因为他们禁忌LGE CMR。

项目成果

Quantification of myocardial hemorrhage using T2* cardiovascular magnetic resonance at 1.5T with ex-vivo validation.

• DOI: 10.1186/s12968-021-00779-4
• 发表时间: 2021-09-30
• 期刊: Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance
• 作者: Chen Y;Ren D;Guan X;Yang HJ;Liu T;Tang R;Ho H;Jin H;Zeng M;Dharmakumar R
• 通讯作者: Dharmakumar R

Cardiovascular Magnetic Resonance in Acute ST-Segment-Elevation Myocardial Infarction: Recent Advances, Controversies, and Future Directions.

• DOI: 10.1161/circulationaha.117.030693
• 发表时间: 2018-05-01
• 期刊: Circulation
• 影响因子: 37.8
• 作者: Bulluck H;Dharmakumar R;Arai AE;Berry C;Hausenloy DJ
• 通讯作者: Hausenloy DJ

The Canadian Cardiovascular Society Classification of Acute Atherothrombotic Myocardial Infarction Based on Stages of Tissue Injury Severity: An Expert Consensus Statement.

• DOI: 10.1016/j.cjca.2023.09.020
• 发表时间: 2023-10
• 期刊: The Canadian journal of cardiology
• 作者: Andreas Kumar;Kim Connelly;Keyur P. Vora;K. Bainey;Andrew Howarth;Jonathon A Leipsic;Suzanne Betteridge-LeBlanc;Frank S. Prato;H. Leong-Poi;Anthony Main;Rony Atoui;J. Saw;Eric Larose;Michelle M. Graham;Marc Ruel;R. Dharmakumar

Retrospective assessment of at-risk myocardium in reperfused acute myocardial infarction patients using contrast-enhanced balanced steady-state free-precession cardiovascular magnetic resonance at 3T with SPECT validation.

• DOI: 10.1186/s12968-021-00730-7
• 发表时间: 2021-03-15
• 期刊: Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance
• 作者: Sun Z;Zhang Q;Zhao H;Yan C;Yang HJ;Li D;Li K;Liu Z;Yang Q;Dharmakumar R
• 通讯作者: Dharmakumar R

Assessment of intramyocardial hemorrhage with dark-blood T2*-weighted cardiovascular magnetic resonance.

• DOI: 10.1186/s12968-021-00787-4
• 发表时间: 2021-07-15
• 期刊: Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance
• 作者: Guan X;Chen Y;Yang HJ;Zhang X;Ren D;Sykes J;Butler J;Han H;Zeng M;Prato FS;Dharmakumar R
• 通讯作者: Dharmakumar R