Myocardial Tissue Characterization with MR Relaxometry in Heart Failure

项目摘要 心力衰竭(HF)已成为心血管内科目前面临的最大挑战。 亚临床心功能不全的检测可以为我们提供一个独特的机会来治疗患者 疾病的早期阶段，并修改危险因素，以防止或减缓心衰的发展和 进步。扩张型非缺血性心肌病(NICM)心衰早期细胞外改变 基质体积(ECV)和心肌纤维化和炎症的形成导致心肌损伤 心功能与心律失常的沉淀。因此，及早发现这些变化可能会 有重大的临床影响。心血管磁共振(CMR)是一种无创、 多面、强大的成像方式，不使用电离辐射，具有高空间性 高分辨率，并提供出色的软组织对比度。急性心肌梗死患者心肌T1和T2弛豫时间变化 间质弥漫性纤维化和炎症的存在。当前CMR的一个主要限制 技术是使用半定量和主观的疾病状态评估。最新研究进展 CMR可以以体素的方式量化松弛时间，以表征心肌组织 成分，类似于心肌局部活检，作为一种独特而强大的工具，它是 是任何其他成像设备所无法比拟的。我们最近开发了新的方法来 准确测量在体心肌T1和T2时间。在这项研究中，我们建议继续 我们多层T1和T2的开发、改进和多中心/多供应商评估 映射序列。同时，在一项试点临床研究中，我们将评估T1的预测价值， 新发现的扩张型NICM患者的T2和ECV对心力衰竭进展和心脏不良的影响 在两年的临床随访中发生的事件。我们还将评估CMR与非CMR的增量价值 心力衰竭进展和不良心脏事件的标志物。

Project Summary Heart failure (HF) has emerged as the greatest current challenge in cardiovascular medicine. Detection of subclinical cardiac dysfunction could give us a unique opportunity to treat patients at an earlier stage of disease and to modify the risk factors to prevent or slow HF development and progression. In HF with dilated non-ischemic cardiomyopathy (NICM), early changes in extracellular matrix volume (ECV) and formation of myocardial fibrosis and inflammation result in impairment of ventricle function and precipitation of arrhythmias. Therefore, early detection of these changes could have significant clinical impact. Cardiovascular magnetic resonance (CMR) is a non-invasive, multifaceted, powerful imaging modality that employs no ionization radiation, has high spatial resolution and provides excellent soft tissue contrast. Myocardial T1 and T2 relaxation times change in the presence of interstitial diffuse fibrosis and inflammation. A major limitation of current CMR technique is use of semi-quantitative and subjective assessment of disease status. Novel advances in CMR allow voxel-wise quantification of relaxation times to characterize myocardial tissue composition, analogous to myocardial regional biopsy, as a unique and powerful tool which is unparalleled by any other imaging modality. We have recently developed novel approaches to accurately measure in-vivo myocardial T1 and T2 times. In this study, we propose to continue development, refinement and multi-center/multi-vendor evaluation of our multi-slice T1 and T2 mapping sequences. Concurrently, in a pilot clinical study, we will assess the predictive value of T1, T2 and ECV in patients with newly recognized dilated NICM for HF progression and adverse cardiac events over a 2-year clinical follow up. We will also assess incremental value of CMR vs. non-CMR markers of HF progression and adverse cardiac events.