Noninvasive assessment of coronary endothelial function by multi-slice MRI

多层MRI无创评估冠状动脉内皮功能

• 批准号: 10456016
• 负责人: Michael Schaer
• 金额: $ 24.56万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10456016
• 关键词: 3-Dimensional; Acute Coronary Event; Anatomy; Area; Arteries; Attenuated; Award; Blood Vessels; Blood flow; Calibration; Cardiac; Cardiac Catheterization Procedures; Cardiovascular system; Catheterization; Cessation of life; Characteristics; Cine Magnetic Resonance Imaging; Clinical; Coronary; Coronary Arteriosclerosis; Coronary artery; Detection; Development; Diagnostic; Dilatation - action; Disease; Disease Progression; Endothelial Cells; Endothelium; Event; Exercise; Exhibits; Fatty acid glycerol esters; Freezing; Functional disorder; Future; Gold; Health; Heart; Heterogeneity; Image; Imaging Techniques; Impairment; Intervention; Isometric Exercise; Knowledge; Life; Location; Magnetic Resonance; Magnetic Resonance Imaging; Measurement; Measures; Mediating; Medical; Methods; Monitor; Myocardial Infarction; Nitric Oxide; Noise; Participant; Patients; Pericardial body location; Persons; Physiologic pulse; Physiology; Population; Reproducibility; Resolution; Rest; Risk; Rupture; Sample Size; Signal Transduction; Slice; Stenosis; Stress; Testing; Thick; Thinness; Time; Tissues; United States; Validation; Water; Work; anatomic imaging; clinical imaging; clinical practice; clinically relevant; constriction; data acquisition; design; disability; endothelial dysfunction; heart motion; imaging approach; imaging modality; in vivo; non-invasive imaging; novel; novel strategies; premature; prognostic; response; stressor; tool; treatment response; two-dimensional

Coronary artery disease (CAD) remains a leading and important cause of disability and premature death in the United States. Conventional clinical imaging characterizes coronary artery anatomy, but because most acute coronary events result from plaque rupture in regions previously exhibiting less than 50% luminal stenosis, current state-of-the-art anatomic imaging cannot predict where plaque progression and events will occur. A new approach is needed and evidence suggests that coronary endothelial function (CEF) imaging can fill this gap. CEF is considered a “barometer” of vascular health because endothelial release of nitric oxide in response to certain stressors is a defining characteristic of healthy vascular tissue that results in arterial dilatation and increased blood flow. Impaired endothelial nitric oxide release, or endothelial dysfunction, is a marker for sub-clinical disease, an independent predictor of future CAD progression and cardiac events, and responds favorably to beneficial medical interventions. Despite the well-established diagnostic and prognostic importance of CEF, it is rarely measured in clinical practice because it was mostly measured with invasive cardiac catheterization. We recently developed a noninvasive magnetic resonance imaging (MRI) means to quantify local CEF that combines 2-dimensional (2D) cine MRI with isometric handgrip exercise (IHE). The main limitation is that the 2D approach only allows CEF measurements at just two to four locations and therefore cannot characterize CEF in multiple arteries or regional heterogeneity present throughout a diseased coronary artery. The aims of our proposal are 1) to develop a new multi-slice MRI method that to assess CEF area changes along proximal to mid segments in all major coronary arteries; 2) to optimize and validate the proposed method’s ability to measure cross sectional areas by assessing both accuracy and precision; and 3) to validate the CEF measures from the proposed method against the noninvasive gold-standard including reproducibility testing in both healthy subjects and stable CAD patients. This work will provide a robust, noninvasive means to better and more comprehensively assess CEF, an independent predictor of future atherosclerotic progression and events, and barometer of response to therapy. Knowledge of accuracy, precision, and reproducibility values will enable us to design future studies investigating novel interventions and monitoring disease progression.

冠状动脉疾病（CAD）仍然是残疾和过早死亡的主要和重要原因， 美国的传统的临床成像表征冠状动脉解剖结构，但由于大多数急性 冠状动脉事件由先前表现出小于50%管腔狭窄的区域中的斑块破裂引起， 当前最先进的解剖成像不能预测斑块进展和事件将在何处发生。一 需要一种新的方法，有证据表明冠状动脉内皮功能（CEF）成像可以填补这一空白。 间隙CEF被认为是血管健康的“晴雨表”，因为在血管内皮细胞中， 对某些应激源的反应是健康血管组织的定义特征，其导致动脉粥样硬化。 扩张和血流量增加。内皮一氧化氮释放受损，或内皮功能障碍，是一种 亚临床疾病标志物，未来CAD进展和心脏事件的独立预测因子，以及 对有益的医疗干预反应良好。尽管有公认的诊断和预后 CEF的重要性，在临床实践中很少测量，因为它主要是用侵入性测量的。 心导管我们最近开发了一种非侵入性磁共振成像（MRI）方法， 量化结合二维（2D）电影MRI与等长握力练习（IHE）的局部CEF。的 主要限制是2D方法仅允许在两到四个位置处进行CEF测量， 因此，不能表征多个动脉中的CEF或整个病变动脉中存在的区域异质性。 冠状动脉我们的建议的目的是：1）开发一种新的多层MRI方法来评估CEF 沿所有主要冠状动脉近端至中段沿着的面积变化; 2）优化和验证 所提出的方法通过评估准确度和精密度来测量横截面积的能力;以及3） 针对非侵入性金标准验证所提出方法的CEF措施，包括 在健康受试者和稳定的CAD患者中进行再现性测试。这项工作将提供一个强大的， 更好、更全面地评估CEF的非侵入性方法，CEF是未来的独立预测因素， 动脉粥样硬化进展和事件以及对治疗反应的晴雨表。准确性知识， 精确度和再现性值将使我们能够设计未来的研究调查新的干预措施 和监测疾病进展。