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: 9922382
• 负责人: Ahmed Aly
• 金额: $ 3.26万
• 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/9922382
• 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; segmentation algorithm; 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.

项目概要/摘要 缺血性二尖瓣反流 (IMR) 是一种正常二尖瓣 (MV) 结构出现功能障碍的疾病 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加剧。 IMR 死亡率很高 甚至与轻度 MR 严重程度相关的比率。采用尺寸较小的环瓣环成形术修复二尖瓣 IMR 的首选治疗策略；然而，12个月内中度或重度IMR复发 手术的情况很常见。心胸外科试验网络 (CTSN) 近期备受瞩目的结果 ticenter 关于 IMR 的随机试验已证实早期复发 IMR 的发生率很高。更重要的是， 这些研究强调了复发性 IMR 对左室重构和临床结果的不利影响。这 CTSN 试验表明 12 个月和 24 个月时左心室容量减少或生存率没有显着差异 维修组和更换组之间；然而，亚组分析表明，修复患者 发生复发性 IMR 的患者左心室体积没有减少，而未复发的修复患者则经历了 左心室容量减少效果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尚未得到满足。这样一个 该工具仅对可能发生瓣膜修复的患者进行瓣膜修复，从而显着减少复发性 IMR 问题 体验持久的结果并对复发风险高的患者进行瓣膜置换术。长的 长期目标是通过改善术前风险分层来提高 IMR 手术治疗的质量 图像分析工具。该提案的总体目标是通过前改进预测 IMR 复发 使该模型包含左心室 (LV)。基本原理是，虽然 IMR 表现为 MV malcoapta- 该病的根本原因是左心室重构。中心假设是从 综合左心室和二尖瓣（LVMV）模型将比目前的模型更准确地预测复发 仅限 MV 的型号。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 的拟合精度 图像与现有仅 MV 模型的图像相比。 2) 评估源自综合的生物标志物的能力 LVMV 模型预测 IMR 复发，并与仅 MV 模型的预测值进行比较。项目 意义重大，因为如果成功，集成的 LVMV 模型将被纳入正在进行的 Gorman 实验室 努力将这项技术转化为手术室，从而提高生存率，减少即将发生的情况 临床负担和重复手术的次数。